CASE REPORT A case of elongated cervical canal L D R Tsatsi MB ChB, FCRad(D)SA S Ahmad MBSS Department of Diagnostic Radiology Medica/ University of Southern Africa A 29-year-old black female patient presented to the gynaecology depart- ment at Ga- Rankuwa Hospital in February 2002 with a complaint of primary infertility. Findings All haematological and clinical parameters were normal. Ultrasound Ultrasound examination revealed a large uterus with multiple intramur- al, submucosal and subserosal fibroids. Two huge fibroids were noted. The dimensions were 10.3 cm x 8.9 cm and 8.9 cm x 5.7 cm. No localised area of cystic breakdown was noted (Figs 1 and 2). CT An axial CT scan was performed in June 2002. The findings were as fol- lows: A large myometous uterus was visible. Multiple subserosal intramur- al and submucosal fibroids were noted. The dimensions of the two largest fibroids were 10.1 x 9.4 cm and 6.9 x 7.1 cm. Density measurements were of soft tissue, Le.30 - 40 HFU. No calcifi- Fig. 1. Transverse sonar scans showing two huge fibrolds. Fig. 2. Transverse sonar scans of the largest fibroid. cation or areas of breakdown were noted. Coronal and sagittal recon- structions were also performed (Figs 3 and4). Hysterosal pingography (HSG) This demonstrated an extremely elongated cervical canal (15 cm). A filling defect was demonstrated at the fundus of the uterus. The filling defect (fibroid) was demonstrated in all views of hysterosal pingography. The uterus was noted to extend to the extent of Ll4 vertebra. 28 SA JOURNAL OF RADIOLOGY • September 2002 Fig. 3. Post HSG - Reconstructed coronal CT showing fibroid uterus with contrast in the peri- tonea/ cavity. Fig. 4. Coronal reconstructed CT images showing a long cervical canal interspersed between two huge flbroids. Opacification of the left tubule system was demonstrated and an accompanying free spill was noted. The right tube showed a tapering proximal filling with complete block- age (Figs 5 and 6). Fig. 5. A very long cervical canal with the uterus becoming an abdominal organ. CASE REPORT Fig. 6. HSG performed in March 2002 showing a long cervical canal. A small filling in the area of fun- dus of the uten..ts with opacification of the left fal- lopian tube only, showing peritoneal spill as well. Conclusion To the best of our knowledge similar elongation of the cervical canal has not been described previously. The cervical canal, which is best shown on HSG with the vaecum injector, is usually 30 - 40 mm long and tends to become shorter after childbirth." The cervical canal is about one-third of the entire length of the uterus and is often spindle- shaped." The cervical canal extends upward 1 - 2 cm from the external os to the internal os, above which there is a short narrow isthmus, which opens into the general uterine cavity. The width of the cervical canal varies with the menstru- al cycle, being wider in the prolifera- tion than in secretory phase 2. References ). Whitehouse GH, Wright CHo Imaging in gynaecology. In: Grainger RG, Allison D. Diagnostic Radiology. 4th ed. London: Churchill Livingstone, 2001: 1827. 2. Highman TH, Lees WR. Gynaecological imag- ing. In: Sutton D. Textbook of Radiology and Imaging. 5th ed. London: Churchill Livingstone, 1993: 1212. 3. Slezak 1', Tillinger KG. The occurrence and signficance of broad longitudinal folds in the uterine cavity at hysterography. Radiology 1973; 106: 87-90. 4. Slezak P, Tillinger KG. The incidence and clini- ca] importance of hysterographic evidence of cavities in the uterine wall. Radiology, 1976: 581-586. 5. Slezak P, Tillinger KG. The significance of the spiculated outline of the uterine cavity on hys- terography. Radiology 1973; 107: 527-531. 6. Slezak P, Tillinger KG. The occurrence and sig- nificance of a double-outlined uterine cavity (DOUC) in the hysterographic picture. Radiology 1968; 90: 756-760. 7. Gerlock AJ, Hooser CWo Oviduct response to glucagon during hysterosalpingography. 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