Ultrasound Female Pelvic Organs

Ultrasound

the first imaging test of choice for Pelvic Organ Imaging.

There is excellent tissue differentiation (depending on body habitus), relatively inexpensive, portable, no radiation.

CT scan

imaging in which it is often difficult to evaluate the pelvic structures. Have to worry about radiation and IV iodine contrast allergies, renal function.

MRI

problem solving imaging for Pelvic Organs. Excellent tissue differentiation depending on body habitus. Able to characterized different tissues (blood, water, fat, calcium). No radiation. IV contrast cannot be used with poor renal function. Have to consider body habitus and claustrophobia.

Transabdominal sonogram (TA)

Pelvic sonogram that uses full ladder as a window. Gives overall view of anatomy. Ovaries/fibroids/other masses may be out of range.

Transvaginal (Endovaginal) sonogram (TV/EV)

pelvic sonogram that requires an empty bladder. Provides high resolution probe in direct proximity to cervix. Much more detail observed, color doppler for blood flow.

- pain/bloating

- vaginal bleeding (pregnant, not pregnant)

- masses

- date early pregnancy

- assess fetal viability/location

- vaginal discharge (PID)

- evaluate follicles

- IUD location

Indications for pelvic US

8x5x4 cm

normal dimensions of the uterus

thin, echogenic stripe

the normal endometrial cavity appears as a ______

full

TA sonogram is taken with a ___ bladder

empty

TV sonogram is taken with a ____ bladder

NS Sonohysterography

imaging in which saline is instilled into endometrial cavity. Distends normally collapsed endometrial cavity to allow for delineation of endometrial polyps, submucosal myomas, and adhesions.

Normal uterus (long view)

Uterus with proliferative endometrium (trans view)

Uterine Leiomyoma (fibroids)

benign smooth muscle tumor. Appear as heterogenous, hypoechoic, solid mass. May undergo degeneration and calcification (popcorn calcification).

Uterine leiomyoma

- submucosal

- myometrial (intramural)

- subserosal (can be pedunculated)

Uterine fibroids can be classified as...

Uterine leiomyoma

Uterine leiomyoma

Adenomyosis

ectopic endometrium within the myometrium causing dysmenorrhea and menorrhagia. Appears as diffusely thickened, heterogenous myometrium. Asymmetric uterine wall thickening.

Adenomyosis

Uterine malignancy

Normal ovary with cysts

functional

majority of ovarian cysts are ________. They are well defined, thin walled, homogenous, anechoic structures.

follicular

ovarian cyst, nondominant follicle fills with fluids and does not rupture

Corpus luteal cysts

ovarian cyst. CL forms after egg is expunged from dominant follicle. If it fills with fluid it forms a ______

Dermoid cysts

Endometriomas

Nonfunctional ovarian cysts...

Dermoid cysts

teratomas are also known as ________ (type of nonfunctional cyst)

Endometriomas

chocolate cysts (nonfunctional)

endometrial cells are transplanted in the ovaries. React to hormones and cause bleeding.

PCOS

endocrine abnormality in which numerous ovarian follicles develop. Various stages of growth or atresia. Causes oligomenorrhea, hirsutism, obesity. String of bead pattern in the periphery

PCOS

serous and mucinous

two common types of ovarian tumors

cystic and benign

most ovarian tumors are _______.

CT or MRI

staging for Ovarian tumors is done via...

- thick, irregular walls

- thick, irregular septations

- vascular flow

- solid papillary projections

malignant findings of ovarian tumors...

Ovarian tumors

Ovarian torsion

sudden onset adnexal pain, surgical emergency. Diagnosis primarily depends on appearance: asymmetrically enlarged, increased stromal echogenicity, doppler flow usually is still demonstrated.

Pelvic inflammatory disease

infection affecting uterus, fallopian tubes and ovaries causing pelvic pain, vaginal discharge, adnexal tenderness, fever, elevated WBC. May appear as periovarian inflammation, enlarged ovaries with multiple cysts, fluid filled and dilated fallopian tubes, tubo-ovarian complex, tubo-ovarian abcess

- r/o ectopic

- estimate gestational age

- determine number of embryos

US in first trimester is done to...

- fetal abnormality detection

- amniotic fluid volume

- placental position

US in the 2nd and 3rd trimester are done to...

Preggo

Ectopic pregnancy

patient with positive pregnancy test

Molar pregnancy

disorder of the placenta. Invasive mole, Choriocarcinoma. Appears as a grape like structure on US. Uterine size is disproportionately large for gestational age. Vomitting and vaginal bleeding.

Molar pregnancy

Hysterosalpingography

X-ray procedure to investigate fallopian tube patency

Uterine polyp of Saline Infusion Sonohysterography

probably can't tell this from just the picture