15 - Radiology of the male and female pelvis Flashcards
When does the uterus move? Does the cervix move?
Position of the uterus moves every-time the bladder fills/empties. Cervix does not move, is very fixed
Where are the ovaries open to?
Lie between the 2 sheets of the broad ligament and are open to the back/posteriorly into the abdominal cavity. Surface on the back of the ovary has the ability when a egg ruptures to be briefly exposed to the intra-abd cavity before the fimbriae get swept up. If have an abd problem like inflam that makes it ‘sticky’ or closes it off, can ovulate but won’t make it to the uterine tubes
What do you tend to use for uterus?
US
- transabd or transvaginal (gives best images)
- fill bladder so gives a clearer image (air in the bowel i.e. gets in the way and a full bladder pushes the bowel away)
Why may a transvaginal approach not be acceptable
- not sexually active
- not used tampon
- culturally not appropriate
Retroverted and retroverted uterus?
anteverted = faced towards rectum retro = faced towards bladder
Retroverted uterus?
25%
Can be associated with problems i.e. IUD insertion can perforate
Easier to scan transvaginally
Endometrium
Very dynamic and active. Thins with age
After ovulation becomes the “halo” for two days
Black area on US behind the cervix??
Water in Pouch of Douglas
- can be physiological or pathological
- just after ovulation (dominant follicle ruptures and the fluid pours out and collects)
- menstruating (fluid and blood)
- pelvic pain? inflam? ectopic pregnancy most likely?
Ectopic pregnancy?
- May not know she’s pregnant (2-3 weeks after fertilisation)
- has not entered uterine cavity (uterus)
- usually in tube and sets up own blood supply and bleed
- order pregnancy test
- could blow tube if leave it
What does an ovary look like?
Almond shape
Has little black dots (follicles)
Polycystic ovary?
Follicles mature but don’t receive hormone signals to rupture. Ovary gets larger, and get bumpy appearance
A lot of fluid in POD/behind and in front of ovary>
usually a malignancy (ascites)
What would you put dye through the cervix into the uterus?
Normally the dye will exit via the uterine tubes into the intra abd cavity. if it doesn’t suggests the tube is blocked. I.e. inflammation (pelvic inflam or appendicitis can block the tubes)
Often done for fertility
Ovulating normally usually but can’t enter uterus
Pelvic floor prolapse?
Can occur after child birth
Can lead to incompetence.
When she stands up often the bladder will drop down and more when strains.
What 3 things do you look at when imaging the male pelvis?
- scrotum
- prostate
- bladder
