Ultrasound Pathology of the Vagina, Cervix, and Uterus

Comprehensive flashcards covering gynecological ultrasound pathology including vaginal cysts, cervical lesions, uterine leiomyomas, cervical stenosis, hysterectomy terminology, and C-section scar findings.

What general rule should always be followed anytime pathology is suspected during a sonogram?

Always put color Doppler on it.

What anatomical structure lies between the bladder and the rectum?

The vagina.

What is the most common cystic lesion of the vagina?

Garner's duct cyst.

What is the typical sonographic appearance of fluid inside a Garner's duct cyst?

Anechoic.

Aside from transabdominally, what scanning technique can be used to image a Garner's duct cyst?

Translabial scanning.

In medical terminology referenced in the lecture, what prefix or term refers to fluid?

Hydro.

In medical terminology referenced in the lecture, what prefix or term refers to blood?

Hemato.

In medical terminology referenced in the lecture, what term refers to pus?

Chio.

What is the most common congenital abnormality of the female genital tract?

Imperforate hymen resulting in obstruction.

At what age range is an imperforate hymen most commonly identified?

Adolescent age.

What two malignant forms of cancer occur in the vagina as solid masses?

Adenocarcinoma and rhabdomyosarcoma.

Why is translabial scanning useful for evaluating vaginal pathology?

Because the vagina is so superficial.

What two anatomical structures are shown on a translabial ultrasound view near the vagina?

The urethra and the anus.

What do the terms "metra" or "metro" refer to in medical terminology?

Uterus.

What does the term "colpos" or "colpo" refer to in medical terminology?

Vagina.

What is hematometrocolpos?

Accumulation of blood in the uterus and vagina.

What is the prefix typically used to refer to the cervix?

Cervico- (c e r v I c o).

What is the vaginal cuff?

The area seen in patients after a hysterectomy representing the upper ligaments of the normal vagina.

What is the normal measurement of a vaginal cuff?

Generally around 2 centimeters.

A vaginal cuff measurement greater than what size is considered suspicious for malignancy?

Greater than 2.1 centimeters.

What organ removal distinguishes a total hysterectomy from a partial hysterectomy?

A total hysterectomy removes both the uterus and cervix, whereas a partial hysterectomy leaves part of the cervix.

What does the surgical abbreviation TAH stand for?

Total Abdominal Hysterectomy.

What does the surgical abbreviation TLH stand for?

Total Laparoscopic Hysterectomy.

What does the surgical abbreviation SH or SCH stand for?

Supracervical Hysterectomy.

What organ remains intact in a supracervical hysterectomy?

The cervix (or part of the cervix).

What does salpingo-oophorectomy refer to?

Surgical removal of the fallopian tubes and ovaries.

What does the term bilateral indicate in a surgical procedure context?

Both sides.

What does BSO stand for in surgical notes?

Bilateral Salpingo-Oophorectomy.

What does the medical abbreviation "s/p" or "status post" mean?

After a procedure or surgery.

Where is the retrouterine recess located?

Between the rectum and the vagina/uterus.

What are two alternative names for the retrouterine recess?

Posterior cul-de-sac and Pouch of Douglas.

What is the most frequent site for fluid collection in the female pelvis?

Retrouterine recess (posterior cul-de-sac).

Why is a small amount of fluid in the posterior cul-de-sac considered normal in menstruating women?

It occurs due to the rupture of a corpus luteum or dominant follicle.

What is ascites?

Free fluid collection in the abdominopelvic cavity.

What clinical conditions can lead to blood accumulation in the posterior cul-de-sac?

A ruptured ectopic pregnancy, ruptured cyst, or pelvic trauma.

What is a hematoma?

A collection of blood resulting from trauma or bleeding (a bruise).

Why are elderly patients particularly prone to developing pelvic or body hematomas after a fall?

Because many of them are on blood thinners.

What junction connects the cervix to the body of the uterus?

Internal os.

What junction connects the cervix to the vagina?

External os.

What is the average normal length measurement of the cervix?

2 to 4 centimeters.

In what patient population is the length of the cervix routinely measured separately on ultrasound?

Pregnant patients.

What is the most common benign finding in the cervix?

Nabothian cyst (inflammatory retention cyst).

What is another medical name for a Nabothian cyst?

Epithelial inclusion cyst.

What is the typical maximum size for a Nabothian cyst?

Usually not more than 2 centimeters.

What is the primary clinical presentation associated with cervical polyps?

Irregular bleeding.

What term describes a polyp that is attached by a narrow stalk?

Pedunculated.

What imaging procedure is used to confirm whether a cervical or endometrial lesion is a polyp?

Sonohysterography (sono hiss).

From what tissue layer do cervical polyps arise?

Hyperplastic protrusion of the epithelium of the endocervix or ectocervix.

What three terms are used interchangeably to describe fibroids?

Myoma, leiomyoma, and fibroid.

What is the most common pelvic or gynecological tumor in women?

Leiomyoma (myoma/fibroid).

What percentage of women are estimated to have leiomyomas?

23 percent.

Leiomyomas are composed of what type of cells?

Spindle-shaped smooth muscle cells.

What microscopic pattern do the smooth muscle cells of a leiomyoma exhibit?

A whorl-like pattern.

What hormone stimulates the growth of leiomyomas?

Estrogen.

Why do fibroids typically shrink after menopause?

Because estrogen levels decrease.

What would be a suspicious finding regarding a fibroid in a postmenopausal woman not taking HRT?

An increase in fibroid size.

What are the main clinical symptoms caused by uterine fibroids?

Irregular menses, heavy menses, enlarged uterus, pain, and infertility.

How can fibroids contribute to female infertility?

By distorting or compressing fallopian tubes or blocking the endometrial canal.

What term describes a fibroid located within the myometrium?

Intramural fibroid.

What is the most common location type for a leiomyoma in the uterus?

Intramural.

What type of fibroid distorts or deforms the endometrial cavity?

Submucosal fibroid.

Which fibroid location is most directly associated with recurrent miscarriages and infertility?

Submucosal.

What type of fibroid projects outward from the uterus and distorts the uterine contour?

Subserosal fibroid.

What specific subserosal fibroid type is attached to the outer uterus by a stalk?

Pedunculated subserosal fibroid.

How does an intramural fibroid affect the overall contour of the uterus?

It makes the uterus bulky or wider but does not change the outer contour.

What happens to long-standing fibroids in older patients over time?

They tend to calcify and cause acoustic shadowing.

What sonographic finding within a solid fibroid indicates cystic degeneration?

Anechoic fluid-filled areas within the fibroid mass.

How can a sonographer differentiate a subserosal fibroid with cystic degeneration from an ovarian cyst?

By identifying a separate normal ovary on ultrasound.

What surgical procedure involves only the removal of a fibroid while preserving the uterus?

Myomectomy.

How does endometrial ablation help treat symptoms of submucosal fibroids?

By removing the endometrial lining to reduce heavy bleeding.

What procedure blocks blood flow to uterine fibroids to shrink them?

Uterine artery embolization.

What non-invasive therapy uses high-frequency sound waves to shrink fibroids?

High-intensity focused ultrasound (HIFU).

What does the term stenosis mean?

Narrowing.

What are six potential causes of cervical stenosis?

Radiation, previous cone biopsy, postmenopausal cervical atrophy, chronic infection, surgery, and cervical cancer.

What is oligomenorrhea?

Abnormally infrequent or shortened menstrual periods.

What is amenorrhea?

Absence of menstrual periods.

What is dysmenorrhea?

Painful menstruation.

Why does cervical stenosis cause infertility?

The narrowed cervical canal blocks the passageway for sperm to reach the uterus.

What is the most common cell type of cervical cancer?

Squamous cell carcinoma.

What term refers to abnormal cervical cells that serve as precursors to cervical cancer?

Cervical dysplasia.

What is carcinoma in situ of the cervix?

Cancer where undifferentiated neoplastic cells replace the full thickness of the epithelium but remain contained (stage 0).

What clinical symptoms are associated with cervical cancer?

Vaginal discharge or bleeding.

Where on the uterus is a normal C-section scar sonographically located?

At the isthmus on the anterior wall near the internal os.

What is a C-section scar defect or niche on ultrasound?

An anechoic fluid collection within the C-section scar.

What is C-section scar dehiscence?

Separation of the myometrial wall at the C-section scar, appearing heterogeneous on ultrasound.