Pediatric Sonography- Female Pelvis

which 2 ducts involving pelvis embryology do both sexes have?

wolfiian ducts

mullerian ducts

what 2 hormones determine a male fetus?

MIS and testoterone

which duct develops into the female organs?

mullerian ducts

what structures do the paramesonephric ducts form?

fallopian tubes

uterus

cervix

upper vagina

which structure develops into the lower part of the vagina?

urogenital sinus

what are the 2 functions of the ovary?

produce oocytes

produce hormones

by birth, a fetus has how many oocytes?

1 million

by a girls period, how many oocytes does a female have left?

under half a million

what are the main reasons for scanning the neonatal pelvis?

mass

ambiguous genitalia

abdo or pelvic cyst found prenatally

what are the main reasons for scanning pelvic in young girls?

vaginal bleeding/discharge

pelvic pain or mass

in neonates, ovarian follicles measure over ____mm

9

true or false- neonates have a prominent endometrium

true

what are the 2 abnormalities associated with arrested development of the mullerian ducts?

uterine agenesis/hypoplasia

unicornuate uterus

Mayer-Rokitansky-Kuster-Hauser syndrome describes complete agenesis of which structures?

uterus and vagina

a unicornuate uterus can cause what complications?

poor pregnancy outcomes

what 3 abnormalities are associated with failure of fusion of the mullerian ducts?

didelphys uterus

bicornuate uterus

arcuate uterus

what is a didelphys uterus?

2 uteruses with no communication between them

what is an arcuate uterus?

uterus with a mild indentation of the endometrium at the fundus

which 2 abnormalities are associated with failure of reabsorption of the mullerian ducts?

complete uterine septum

incomplete uterine septum

what is the most common mullerian duct malformation of the uterus?

septate uterus

what are the causes of genital tract obstructions?

imperforate hymen

transverse vaginal septum

vaginal atresia or stenosis

what term describes premenstrual vaginal secretions trapped in the vagina?

hydrocolpos

what term describes blood trapped in the uterus and vagina?

hematometrocolpos

what are the clinical presentations of a genital tract obstruction in neonates?

abdominal mall

what are the clinical presentations of a genital tract obstruction after puberty?

amenorrhea

cyclical pain

what is the sonographic appearance of a genital tract obstruction?

Pear-shaped cystic mass arising out of the pelvis containing fluid

Hydronephrosis due to obstruction from the mass

what finding must always be considered in the differential diagnosis of a pelvic mass in girls 9 years of age or older?

pediatric pregnancy

why can a pediatric pregnancy be more dangerous?

they're more suseptable to complications such as toxemia, preeclampsia, abruption ,etc

what pathologies should be ruled out with the finding of ambiguous genetalia?

congenital adrenal hyperplasia

renal defects

what is an infection of the upper genital tract usually caused by gonorrhea or chlamydia?

pelvic inflammatory disease (PID)

what can PID cause?

infertility

ectopic pregnancy

chronic pelvic pain

what is the sonographic appearance of acute PID?

enlarged hypoechoic uterus

fluid in endo

what is the sonographic appearance of chronic PID?

pyosalpinx & hydrosalpinx

enlarged hypoechoic uterus

fluid in endo

what is the sonographic appearance of a tubo-ovarian abscess?

well defined

heterogenous mass in adnexa

internal debris & septations

what is a primary complication of PID?

perihepatitis and peritonitis

neonates are at risk for larger pelvic cysts if the mother has what conditions?

toxemia

diabetes

Rh isoimmunization

which type of pelvic cyst is filled with clear serous fluid?

follicular cyst

which type of cyst has the ring of fire doppler appearance?

corpus luteum cyst

which type of cyst is caused by high hCG or gestational trophoblastic disease?

theca lutein cyst

which type of cyst originates from the broad ligament and is rare in kids?

paraovarian cyst

what complications are associated with pelvic cysts?

ovarian torsion

hemorrhage

rupture

why can prepubertal girls be more at risk for ovarian torsion?

due to excessive mobility of the adnexa

what are the signs/symptoms of ovarian torsion?

acute onset of abdo pain

N & V

leukocytosis

what is the sonographic appearance of ovarian torsion?

unilateral ovarian enlargement

FF in PCDS

cyst or tumour

target or whirlpool sign on color

absence of flow

what is the sonographic appearance of a hemorrhagic cyst?

heterogenous mass

thick walls

septations

FF in PCDS

what are the clinical presentations of PCOS?

hirsutism

irregular menstrual bleeding

infertility

obesity

diabetes

what is the sonographic appearance of PCOS?

bilaterally enlarged rounded ovaries

increased number of follicles

what is the sonographic appearance of a dermoid cyst?

cystic possibly with mural nodule

solid

fat-fluid or hair-fluid levels

calcifications

what is the sonographic appearance of dysgerminoma?

large

solid

encapsulated

hypoechoic areas from necrosis/hemorrhage

what is a stromal tumour associated with feminizing effects and precocious puberty?

granulosa theca cell tumor

what is a stromal tumour composed of gonadal elements?

gonadoblastoma

is the vagina or uterus a more common site of neoplasm in children?

vagina

what is a highly malignant germ cell tumor of vagina?

rhabdomyosarcoma

what is the cause of vaginal carcinoma in kids?

DES exposure in utero

rhabdomyosarcoma of the vagina affects what ages?

6-18 months old

what is the clinical presentation of vaginal rhabdomyosarcoma?

vagina bleeding

prostrusion of polypoid cluster of masses

what is the sonographic appearance of vaginal rhabdomyosarcoma?

solid

homogenous mass that fills vaginal cavity

enlargement of uterus with irregular contour

what is the most common endocrine anomaly associated with primary amenorrhea?

gonadal dysgenesis

what term describes the development of secondary sexual characteristics, gonadal enlargement, & ovulation before age 8 yrs?

precocious puberty

what is the sonographic appearance of precocious puberty?

Uterus enlarged with postpubertal shape

fundus/cx ratio - 2:1 to 3:1

Prominent endometrium

Ovarian volume > 1cc, with functional cysts

central precocious puberty will have what lab values?

high FSH and LH

low estrogen

peripheral precocious puberty will have what lab values?

high estrogen

low FSH and LH

what are the causes of central precocious puberty?

idiopathic

intracranial tumour

what is the cause of peripheral precocious puberty?

ovarian tumour