Contrast-enhanced ultrasound evaluation of a refractory ovarian endometrial cyst and ultrasound-guided aspiration sclerotherapy using urokinase and lauromacrogol

Abstract

Endometriosis is one of the most common diseases that happen in reproductive women. The main symptoms include ovarian endometrial cyst, pelvic pain, and so on. We report a case of a 23-year-old woman with a refractory long-course ovarian endometrial cyst (OEC). The patient was previously identified to have a hypoechoic mass sized 9.7 cm in diameter on ultrasound (US) in the right ovary and was tentatively diagnosed as OEC in another tertiary hospital, who was then subjected to US-guided cyst sclerotherapy while the procedure was failed since only a very small amount of viscous and sticky fluid can be aspirated. The patient was then referred to our hospital for further treatment. Pretreat contrast-enhanced ultrasound (CEUS) showed non-enhancement of the mass with a thin cyst wall and a cyst-in-cyst pattern was observed. The possibility of ovarian malignancy was ruled out and the initial diagnosis of OEC was confirmed. The patient was then subjected to US-guided cyst sclerotherapy with lauromacrogol. The interventional procedure was eventful that no fluid was aspirated as what happened in the previous hospital. Thus urokinase was used to dissolve the old, viscious and sticky blood and finally, all the fluid was aspirated. The total consumption of urokinase was 60,000 U. Then lauromacrogol as a sclerosant was injected into the cyst cavity and the cyst wall was flushed repeatedly with lauromacrogol until the aspirated fluid became light red. Finally, 20 mL lauromacrogol was reserved in the cyst and the interventional procedure cost 2 hours The post-procedure course was uneventful without any discomfort, and the volume reduction rate of the cyst was 54%at 3-month follow-up. The visual analogue scale for the pain decreased from 4 before treatment to 1 after treatment, indicating a successful and effective outcome for the refractory long-course OEC.

Ultrasound-Guided Transvaginal Aspiration and Sclerotherapy for Uterine Cystic Adenomyosis: Case Report and Literature Review

“…A preliminary experimental study showed that lauromacrogol injection produced significant regression of endometrial foci ( 58 ). Ultrasound-guided aspiration sclerotherapy using lauromacrogol is a successful and effective treatment for refractory long-course ovarian endometrial cysts ( 59 ). In the present case, the functional endometrial tissue within the lesion was completely ablated by lauromacrogol, and the muscle layer surrounding the lesion was not damaged, retaining the integrity of the uterine wall.…”

The effect of ultrasound‐assisted thrombolysis studied in blood‐on‐a‐chip

“…Recently, ultrasound‐assisted thrombolysis (UAT) has emerged as a potential strategy to mitigate bleeding issues linked to conventional thrombolytic drugs while significantly enhancing therapeutic efficacy at lower doses 6 . The interplay between ultrasound (US) and UK has garnered significant attention in recent medical research, particularly in the context of thrombolysis and targeted drug delivery 7–10 . An ultrasound‐responsive nanoliposome capsule has been developed for the controlled release of UK, aimed at treating acute pulmonary embolism, that uses the ultrasonic cavitation effect and a sonosensitizer to generate singlet oxygen that breaks the bond in the liposome, thereby rapidly releasing UK 8 .…”

“…6 The interplay between ultrasound (US) and UK has garnered significant attention in recent medical research, particularly in the context of thrombolysis and targeted drug delivery. [7][8][9][10] An ultrasound-responsive nanoliposome capsule has been developed for the controlled release of UK, aimed at treating acute pulmonary embolism, that uses the ultrasonic cavitation effect and a sonosensitizer to generate singlet oxygen that breaks the bond in the liposome, thereby rapidly releasing UK. 8 US combined with UK and Arg-Gly-Asp sequence (RGDS)targeted microbubbles in a rabbit model showed that complete recanalization could be achieved, with histological observations confirming the effective dissolution of thrombi.…”

Effects of lauromacrogol injection under contrast-enhanced ultrasound guidance on cesarean scar pregnancy: a prospective cohort study

“…Lauromacrogol is a novel agent for blood vessel hardening that is widely applied in the sclerotherapy of multiple diseases, including hemangioma, venous malformations, ovarian cysts, uterine fibroids, and varicosity (11)(12)(13)(14). It can provoke endothelial maceration and destroy the cellular elements by acting as a detergent on the phospholipid layer of the cell membrane.…”

“…It can provoke endothelial maceration and destroy the cellular elements by acting as a detergent on the phospholipid layer of the cell membrane. This medicine has no mutagenic, carcinogenic, or embryotoxic effect and will not produce pain or extravasation necrosis (11)(12)(13)(14). Currently, there are only two reports of the use of lauromacrogol in managing CSP as a safe, novel therapeutic approach for CSP (2,14).…”