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Sonography, CT, and MRI Appearance of the Essure Microinsert Permanent Birth Control Device

Michael H. Wittmer1, Douglas L. Brown1, Robert P. Hartman1, Abimbola O. Famuyide2, Akira Kawashima1 and Bernard F. King1

1 Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
2 Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.


Figure 1
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  		Fig. 1 —Photograph of Essure microinsert (Conceptus, Inc.). Noted are two radiopaque markers at ends of inner (central) coil (long arrows), and two radiopaque markers at ends of outer (spring) coil (short arrows). Portion of inner coil is surrounded by white polyethylene terephthalate fibers. Inner coil end of device is placed into fallopian tube, and outer coil protrudes into uterine cavity.

 

Figure 2
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  		Fig. 2A —39-year-old woman for whom hysteroscopic still image was taken after placement of Essure devices (Conceptus, Inc.). Shown are proximal tip of inner central coil (small arrow) and proximal tip of outer spring coil (large arrow). Also noted are tubal ostia in each cornu of uterus (arrowheads). Few loops of expanded outer coil can be seen in uterine cavity.

 

Figure 3
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  		Fig. 2B —39-year-old woman for whom hysteroscopic still image was taken after placement of Essure devices (Conceptus, Inc.). Hysterosalpingogram (HSG) of Essure devices (arrows) in satisfactory position. No free spill of contrast agent is seen, indicating tubal occlusion bilaterally. Balloon catheter (arrowhead) used for HSG is noted.

 

Figure 4
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  		Fig. 3A —Sonograms of 37-year-old woman with Essure device implant (Conceptus, Inc.). Transverse transabdominal sonographic image of pelvis shows two parallel interrupted echogenic lines, corresponding to outer coil of Essure device (arrows).

 

Figure 5
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  		Fig. 3B —Sonograms of 37-year-old woman with Essure device implant (Conceptus, Inc.). Transverse endovaginal sonography image of pelvis shows Essure device as two parallel interrupted echogenic lines, corresponding to outer coil (arrows) of device in left fallopian tube.

 

Figure 6
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  		Fig. 3C —Sonograms of 37-year-old woman with Essure device implant (Conceptus, Inc.). Within outer coil of device in right fallopian tube, one is able to identify linear, echogenic line, corresponding with inner coil (arrows) of Essure device.

 

Figure 7
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  		Fig. 4A —29-year-old woman with Essure device implant (Conceptus, Inc.) seen on CT. Consecutive 5-mm slice thickness CT scans, obtained through pelvis (progressing superior to inferior from A to D) and displayed using soft-tissue windows, show linear regions of high attenuation (short arrows), (A and D) corresponding to Essure microinserts within uterine cornua, extending into proximal fallopian tubes. Radiopaque markers at ends of inner and outer coils generate small amount of radiating rays of artifact (long arrows), (B and C).

 

Figure 8
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  		Fig. 4B —29-year-old woman with Essure device implant (Conceptus, Inc.) seen on CT. Consecutive 5-mm slice thickness CT scans, obtained through pelvis (progressing superior to inferior from A to D) and displayed using soft-tissue windows, show linear regions of high attenuation (short arrows), (A and D) corresponding to Essure microinserts within uterine cornua, extending into proximal fallopian tubes. Radiopaque markers at ends of inner and outer coils generate small amount of radiating rays of artifact (long arrows), (B and C).

 

Figure 9
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  		Fig. 4C —29-year-old woman with Essure device implant (Conceptus, Inc.) seen on CT. Consecutive 5-mm slice thickness CT scans, obtained through pelvis (progressing superior to inferior from A to D) and displayed using soft-tissue windows, show linear regions of high attenuation (short arrows), (A and D) corresponding to Essure microinserts within uterine cornua, extending into proximal fallopian tubes. Radiopaque markers at ends of inner and outer coils generate small amount of radiating rays of artifact (long arrows), (B and C).

 

Figure 10
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  		Fig. 4D —29-year-old woman with Essure device implant (Conceptus, Inc.) seen on CT. Consecutive 5-mm slice thickness CT scans, obtained through pelvis (progressing superior to inferior from A to D) and displayed using soft-tissue windows, show linear regions of high attenuation (short arrows), (A and D) corresponding to Essure microinserts within uterine cornua, extending into proximal fallopian tubes. Radiopaque markers at ends of inner and outer coils generate small amount of radiating rays of artifact (long arrows), (B and C).

 

Figure 11
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  		Fig. 5A —41-year-old woman with Essure device implant (Conceptus, Inc.) seen on MRI. Axial (A) and coronal (B) gadolinium-enhanced gradient-echo MR images with fat saturation through pelvis show metallic artifact related to Essure devices (arrows) in place in bilateral fallopian tubes. In coronal image (B), entire length of device on left is shown, and right device is seen in cross section.

 

Figure 12
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  		Fig. 5B —41-year-old woman with Essure device implant (Conceptus, Inc.) seen on MRI. Axial (A) and coronal (B) gadolinium-enhanced gradient-echo MR images with fat saturation through pelvis show metallic artifact related to Essure devices (arrows) in place in bilateral fallopian tubes. In coronal image (B), entire length of device on left is shown, and right device is seen in cross section.

 

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