Ch. 41-43, 48, 51-52 Flashcards
1
Q
UT size, USA
A
6-8 x 3-5 x 3-5 cm
homogeneous mid-gray
2
Q
Endo size, USA
A
menarche 4-14mm; post-men 4-10mm
hypo area surrounding echogenic endo stripe
3
Q
OV size, USA
A
3 cm length
ovoid mid-gray w/ or w/o follicles
4
Q
Leiomyomas aka myomas or fibroids
A
Most common gyne tumor
UT irregularity, enlargement, infertility
Early signs are enlarged UT or distorted contour
May: shadow, have cystic or hyperech areas
5
Q
Submucosal Leiomyoma
A
Distorts Endo
Irregular, heavy bleeding, infertility
Hypoechoic w/in or displacing endo
6
Q
Intramural Leiomyoma
A
Within myometrium
Infertility or recurrent PG loss
Hypoechoic w/in wall
7
Q
Subserosal Leiomyoma
A
Projects out of myometrium
Enlarges and causes pressure
Hypoechoic w/in wall, distorting UT contour
8
Q
Pedunculated Leiomyoma
A
Subserosal on long STALK; can migrate and implant into surrounding structures
Hypoechoic mass near UT
9
Q
Intracavitary Leiomyoma
A
Pedunculated submucosal; extends into UT cavity; can pass through CX
Well-defined hypoechoic mass w/shadowing
10
Q
Hydrometra
A
Accumulation of fluid in endo cavity from cx stenosis
Central cystic area
11
Q
Pyometra
A
Associated w/UT cancer and infection
Central cystic area w/echogenic debris
12
Q
Adenomyosis
A
Benign, endometriosis (ectopic endometrium) w/in the myometrium; mostly posterior
Diffuse UT enlarge w/ thickened posterior myometrium; indistinct border btwn endo and myometrium
13
Q
Endometriosis
A
Ectopic functioning endo tissue that cyclically bleeds
Anywhere in pelvis; diffuse or localized
USA varies; OVs may adhere to structures
14
Q
PID
A
Pelvic infection (endometritis, salpingitis, hydrosalpinx, pyosalpinx, TOA); bilateral fluid/pus in pelvis USA- FF in c-d-s, incr. vasc, thickened endo, fluid w/in endo, enlarged ov w/multiple cysts and indistinct margins
15
Q
Cervical Stenosis
A
Acquired obstruction of cx canal
Distended, fluid-filled UT; intracavitary FF
16
Q
Cervical Polyps
A
Benign hyperplastic; may protrude out of CX; late-middle ages
USA- may not be seen or hypoechoic-echogenic
17
Q
Endometrial Carcinoma
A
Most common gyne malignancy in N America
Thickened endo (>4-5mm) w/myometrial invasion; enlarged UT w/irregular areas of low echoes
FF and symptoms incr. risk of malign.
18
Q
UT calcifications
A
Calcium deposits occur on walls of UT; caused by myomas and arcuate artery calc. (Monckeberg’s arteriosclerosis- can indicate underlying disease such as diabetes, htn, and renal failure).
Focal areas of increased echogenicity w/shadowing or as peripheral echogenic rim
19
Q
Endometritis
A
Endometrium infection;
From PID, postpartum, pelvic instruments;
Intense pelvic pain
Prominent endo, irregular, or both w/small amount of fluid; ff or pus in c-d-s
20
Q
UT AVM
A
Vascular network of arteries and veins w/o intervening capillary network; usually myometrium;
US- serpiginous anechoic structures; tubular structures w/in myometrium
21
Q
Endo Hyperplasia
A
Overgrowth of endo from unopposed estrogen stimulation;
Abnormal UT bleeding; may precede Endo CA
US- abnormal diffuse thickened endo
22
Q
Post menopausal bleeding
A
Most pts are experiencing endo atrophy but may need more evaluation if it’s thickened.
23
Q
IUD
A
Strings hang thru cx;
US- echogenic linear structure in endo cavity w/in UT body.
24
Q
Menorrhagia
A
Prolonged/profuse bleeding;
Assoc w/ adenomyosis
25
Metrorrhea
Irregular acyclic bleeding;
| Assoc w/ adenomyosis
26
Dysmenorrheal
Pelvic pain during menses;
| Assoc w/ adenomyosis
27
Amenorrhea
Absent menses
28
Gartner's Duct Cyst
Most common cystic lesion of vagina; usually found incidentally;
US- true cyst- anechoic w/enhancement
29
Vaginal cuff
After hysterectomy; should be
30
Theca-lutein cysts
Largest functional ov cyst; assoc w/elevated hcg and gestational trophoblastic disease
31
Teratoma
| Aka Dermoid
Solid tumor composed of germ layers; teeth, bones, fat;
Present as abdominal mass or pain or asymptomatic;
US- varies w/elements; small to 40 cm; echogenic components w/shadowing; "tip of the ice berg"
32
Endometrioma "chocolate cyst"
Localized endometriosis frequently found in ov, c-D-s, posterior UT, etc.
US- focal cystic mass w/diffuse low level echoes and enhancement
33
Paraovarian cyst
Cyst adjacent to ov arising from broad ligament;
| US- normal ipsalateral ov close to but separate from cyst; may have echoes from blood
34
Mucinous cystadenoma
Benign ov tumor; thin walled multilocular cyst; can be very large(>100 lbs)
US- simple or septated cyst, often containing internal echoes w/compartments differing in echogenicity
35
Mucinous cystadenocarcinoma
Malignant ov tumor; may become very large;
| US- thick septations w/irregular walls and papillary projections and echogenic material.
36
Serous cystadenoma
2nd most common benign tumor of ov (after Dermoid).
Smaller than mucinous
US-unilocular, homogeneous, often bilateral and w/calcs
37
Serous cystadenocarcinoma
Most common ov CA. May be bilateral w/multilocular cysts;
| US- smaller than mucinous, irregular borders, calcs, ascites
38
Arrhenblastoma
Maculinizing ov tumor;
Pelvic mass, amenorrhea, infertility
Peak at 25-45 yrs
US- solid mass w/cystic parts, loculated, encapsulated, unilateral sizes 2-30cm
39
Sertoli-Leydig Cell tumor
| aka Androblastoma
Women under 30
Unilateral, virilization, excess estrogen
May become malignant
US-solid, hypoechoic mass
40
Granulosa
Feminizing, resembles Graafian follicle
Precocious puberty, vag bleeding, full breasts
May twist/rupture leading to Meig's (ascites or pleural effusion)
US-similar to endometrioma (cystic w/diffuse low level echoes)
41
Dysgerminoma
Rare malignant germ cell tumor
| Solid ov mass is women
42
Fibroma
Benign mass from ov stroma (fibrous), rarely functioning
| US-unilateral w/variable appearance, hypoechoic w/shadowing, may be pedunculated and prone to torsion
43
Corpus luteum
Small endocrine structure that develops from a ruptured follicle and secretes progesterone and estrogen.
44
Corpus luteum cyst
Can result from failure of resorption or from excess bleeding into the corpus luteum. If ovum fertilized, CL cyst of pregnancy continues through 1st trimester w/max. size at 10 weeks and resolution by 12-16 weeks
45
Nabothian cysts
| aka Epithelial inclusion cyst
From dilated transcervical glands- common in mid-aged women;
46
Follicular cyst
Mature follicle that fails to ovulate; unilateral, asymptomatic,
47
Hemorrhagic cyst
From internal hemorrhage of follicular of corpus luteum cysts; acute pelvic pain
US-varies w/amount and age of hemorrhage; acute is hyperechoic and may look solid w/enhancement; appears more echogenic w/time
48
Metastatic Disease
CA spreads from other organs- most often in OV;
US- bilateral, ascites, solid or solid w/"moth-eaten" cystic pattern;
Lymphoma to ov US- solid, hypoechoic mass
49
Ovarian Torsion
Twisted ov, common w/adnexal masses; surgical emergency;
US-enlarged swollen ov, usually >4cm;
Classic US-multiple tiny follicles around a hypoechoic mass
Common US- solid adnexal mass, absent blood flow
50
PCOS
Endocrine disorder w/chronic anovulation;
Stein-Leventhal (infertility, oligomenorrhea, hirsutism, obesity)
US-OVs normal or enlarged w/echogenic stroma, bilaterally multiple small follicles "string of pearls"
51
Ovarian hyperstimulation syndrome
Seen in PTs undergoing ovulation induction following FSH or GnRH, followed by hcG (infertility treatment)
US-enlarged OVs w/multiple cysts, ascites, pleural effusion
52
Ovarian cancer
"Silent cancer" because usually not detected until stage II or III
Stage I- limited to OVs w/ascites
Stage II- limited to pelvic organs w/ascites
Stage III- Limited to abdomen outside pelvis and small bowel
Stage IV- Hematogenous (liver parenchyma) and beyond abdomen
53
Common Cystic or Homogeneous OV masses
```
Follicular
Corpus luteum of pregnancy
Cystic teratoma
Paraovarian cyst
Hydrosalpinx
Endometrioma
Hemorrhagic cyst
```
54
Common Complex Masses of OV
```
Cystadenoma
Dermoid cyst
Tubo-ovarian abscess
Ectopic PG
Granulosa cell tumor
```
55
Common Solid Masses of OV
```
Solid teratoma
Adenocarcinoma
Arrhenoblastoma
Fibroma
Dysgerminoma
Torsion
```
56
Salpingitis
Fallopian tube infection; acute, subacute, or chronic
Presents as pelvic fullness w/fever or asymptom.
US-nodular thickening, irregular tube w/diverticula, tortuous
57
Pyosalpinx
Pus in inflamed fallopian tube as result of obstruction
| US- complex mass; pus w/in dilated tube very thick=hypoechoic
58
Oophoritis
Form of PID that is infection of the OV
| US-enlarged OV w/ multiple cysts and indistinct margins, incr. vascularity
59
Tubo-ovarian Abscess (TOA)
Infection of fallopian tube and ov; adhesions fuse the inflamed ov and tube together, causing abscess
US-complex mass w/septations, irregular margins, and internal echoes, usually in c-d-s
60
Parametritis
PID infection of UT serosa and broad ligaments
61
Myometritis
PID infection of UT wall
62
Peri-ovarian inflammation
PID infection surrounding OV
| US-enlarged ov w/multiple cysts, indistinct margins
63
Tubo-ovarian complex
Fusion of inflamed dilated fallopian tube and ov
| US-complex mass w/septations, irregular margins, and internal echoes, usually in c-d-s
64
Perihepatic inflammation/ Fritz-Hugh-Curtis syndrome
PID travels upward through right flank and mimics GB, liver, kidney pain (commonly w/gonorrhea)
US-hypoechoic rim along liver margin between liver and the adjacent ribs
65
Peritonitis
Inflammed peritoneum caused by infectious organisms (from instrumentation, surgery, female genital tract, etc.)
US-loculated areas of fluid w/in pelvis, paracolic gutters, and mesenteric reflections; ascites; abscess w/gaseous bubbles
66
Pelvic abscess
Infectious process in pelvis (bladder, ureter, bowel, adnexa)
US-loculated areas of fluid w/in pelvis; ascites; abscess w/gaseous bubbles
67
Ectopic Pregnancy
Pg outside of UT fundus; pelvic pain, vaginal bleeding, empty UT, adnexal mass, positive pg test.
Most often in fallopian tube, but can be in OV, broad ligament, peritoneum, cx, and cornua
Complications include hemorrhage, hysterectomy, death
US- complex adnexal mass w/empty UT; may have concurrent IUP or pseudoGS
68
Fetal cardiac activity
When GS= 9mm or TV CRL= 4mm
69
Anembryonic pregnancy/Blighted ovum
GS in which embryo fails to develop or stops developing before detectable on US. GS may continue to grow and hcG may still rise. MSD
70
Gastroschisis
Opening in abdomen wall, usually to right of umb. cord; bowel and organs may protrude outside of abdomen
US-anterior wall defect containing bowel, commonly to the right of umb. cord insert
71
Midgut herniation
Normal bowel herniation into umb. cord to allow for fetal growth
US- echogenic mass at base of umb. cord between 8-12 weeks.
72
Omphalocele
Bowel and/or abdominal organs herniate into umb. cord abnormally; bowel-only are highly assoc w/cardiac, cns, renal, and chromosomal anomalies
US-organ herniation in the cord at any GA; bowel herniated into cord beyond 12 weeks; look for cord membrane around herniation
73
Iniencephaly
Rare, lethal cranial development abnormality w/ 1) defect in the occiput 2) extreme retroflexion of spine "star gazer" 3) open spinal defects
74
Anencephaly
Absence of brain and cranial vault w/cerebral hemispheres missing or reduced to small masses
US-seen near end of 1st trimester; absence of cranium superior to orbits; brain may be projecting from open cranium
75
Acrania
Partial/complete absence of cranium; ossification of cranium should begin after 9 weeks
US- abnormal shaped head "Mickey Mouse" head, lacking echogenic bony cranium
76
Spina bifida
Neural tube fails to close after 6 weeks' GA; detected at end of 1st trimester
US- spinal irregularities or bulging of posterior contour of spine; extrusion of mass from vertebral column; Cranial signs- lemon (scalloping frontal bones) and banana (curved looking cerebellum)
77
Dandy-Walker malformation
Cystic dilation of the 4th ventricle w/dysgenesis or complete agenesis of cerebellar vermis; hydrocephaly; Reported as early as 11 weeks
US- large posterior fossa cyst continuous w/4th ventricle, absent cerebellum, dilated 3rd and lateral ventricles
78
Cystic hygroma/ Turner's syndrome
Dilation of jugular lymph sacs b/c of improper drainage of lymphatic system into venous system. Lg, septated hygromas assoc w/Turner's and Down's, CHF, and fetal demise in utero
US- vary in size, fluid structure on posterior aspect of fetal neck and upper thorax; may have nuchal thickening
79
Pseudogestational sac
False intraUT sac w/ectopic pg. 1)pseudoGS does not contain live embryo or YS 2)is centrally located w/in endo 3)often contains homogeneous level echoes
US-sac w/o YS, centrally in UT, homogeneous echoes; no peritrophoblastic flow
80
Gestational trophoblastic disease aka Molar PG
Trophoblastic tissue overtakes pregnancy; partial/complete
US-varies w/age; "snowstorm" appearance of hydatidiform mole; distorted GS shape w/thin, weak choriodecidual reaction; absence of double decidual sign; "cluster of grapes"
81
Complete abortion
all POCs expelled; may have bleeding and cramping
| US- empty UT; no adnexal mass; no FF; positive hcG levels w/rapid decline
82
Incomplete spontaneous abortion
POCs remain in UT; may have bleeding and cramping
| US-variable; intact GS w/nonviable embryo to collapsed sac; thickened endo >8mm; RPOCs
83
Subchorionic hemorrhage
Low pressure bleed from implantation btwn myometrium and margins of GS; can lead to PG loss if large enough
US-crescent-shaped collection; echotexture depends on time (decr. echogenicity w/time); extension of hemorrhage toward placental margin
84
Placental hematoma
Embryonic placenta detaches, resulting in hematoma w/in chorionic sac; asymptom.; may lead to fetal loss
US-similar to subchorionic (hyper- then hypo- then anechoic)
85
Tachycardia/Bradycardia
Fetal heart rate 90-170
Brady assoc w/poor prognosis
Tachy leads to heart failure and fetal hydrops
86
Cervical/Cornual PG complications
Very vascular areas- cornual may be worst. Hemorrhage upon rupture may result in uncontrolled bleeding and hysterectomy
87
Nuchal translucency
Max thickness of subcutaneous lucency at back of neck at 11-14 weeks; incr. measure assoc w/trisomy, etc.
US-fetus 11-13 wks 6 days, CRL btwn 45-84mm; image midsagittal plane w/embryo away from amniotic membrane and head in neutral position.
88
Macrosomia/Gest Diabetes/Placenta
Birth weight >4000g (above 90th percentile)
1)Generally large (genetics, long pg, etc)
2)Large w/large shoulders (diabetes)
3)Large head only (genetics/pathology)
US-Biometry measurements; placental thickness >5cm
89
Heterotopic Pregnancy
Simultaneous IUP and ectopic; very rare
| US-IUP w/extrauterine sac in adnexa w/thickened echogenic ring
90
Macrosomic Index
Chest circumference-BPD
91
Caudal regression syndrome
Lack of development of caudal spine and cord- seen almost exclusively w/diabetic mothers
92
Conjoined twins
```
Incomplete embryo division after day 13
Thoracopagus (joined at thorax)
Omphalopagus (joined at anterior wall)
Craniopagus (joined at cranium; syncephalus=conjoined twins w/1 head)
Pygopagus (joined at ischial region)
Ischiopagus (joined at buttocks)
```
93
Monozygotic
One zygote splits to form identical twins
0-4 days: Di Di
4-8 days: Mono Di
8-13 days: Mono Mono
94
Di Di
Thick membrane between embryos and GS "twin peaks" or delta sign
95
Mono Di
Most common monozygotic
| thin membrane btwn embryos "floating"
96
Mono Mono
No separation of embryos
| Risk of cord entanglement
97
Dizygotic
Fraternal twins arise from 2 separate fertilized ova
| Placentas may fuse but still have 2 distinct blood circulations separate from each other
98
Preeclampisa/Eclampsia
Pregnancy induced HTN w/proteinuria; edema; assoc w/small placentas and IUGR
US-monitor AFI and fetal growth
99
Hyperemesis Gravidarum
Excessive vomiting in pg leads to dehydration and electrolyte imbalance
US-R/O other causes of vomiting (gallstones, ulcers, trophoblastic disease-by demo viable IUP)
100
Fetal hydrops- immune
Fluid collections caused by Rh incompatibility
US-scalp edema, pleural effusion, pericardial effusion, ascites, polyhydramnios, thickened placenta
Doppler of middle cerebral artery demo fetal anemia (increased velocity)
101
Fetal hydrops- nonimmune
Fluid collections in at least 2 areas of fetus; pleural, pericardial, ascites, skin edema
US-extensive fluid or ff in fetal tissues or body cavities
102
Alloimmune thrombocytopenia
Mother's immune response to fetal platelets (like Rh response); leads to fetus w/very low platelet count; risk of cerebral hemorrhage in utero
US- evidence of fetal hemorrhage
103
Hypertensive pregnancies
High blood pressure; small placentas; IUGR; eclampsia
| US-monitor AFI and fetal growth; Doppler for maternal and fetal circulation status
104
Spalding sign
Fetal death- overlap of skull bones
105
Fetus papyraceous
Fetal death of a vanishing twin when too large to reabsorb; fetus markedly flattened from loss of fluid and most of the soft tissue
106
Poli-oli sequence "Stuck twin"
Diamniotic pg w/polyhydramnios in 1 GS and severe oligohydramnios and smaller twin in the other; assoc w/twin-to-twin transfusion
US- smaller twin appears stuck in position w/in UT
107
Premature labor
Before 37 weeks GA; preterm infants have greater risk for problems (respiratory, intracranial hemorrhage, bowel immaturity, feeding problems)
108
Acardiac anomaly
Rare in monochorionic twins where 1 twin develops w/o a heart and often w/o upper half of body
109
Twin-to-twin transfusion
An AV shunt develops w/in placenta causing arterial blood from 1 twin to pump into venous system of other twin; Donor twin becomes anemic and IUGR w/oligohydramnios; Recipient twin may be large, have polyhydr, go into heart failure
US- growth discordance, AFI for both
110
Predictors of discordance in twin growth
Difference in: EFW of more than 20%
BPD of 6mm
AC of 20mm
FL of 5mm
