Chapter 31

Question 1

also called leiomyomas; represent an
overgrowth of uterine smooth muscle that forms a tumor.

Leiomyosarcoma is the rare malignant form. They are most common in women and are present in 40% of women aged more than 40 years. They may be intracavitary, submucosal, intramural, subserosal, or pedunculated.

They usually growth progressively during the menstrual years, but may shrink after menopause.

Common symptoms are heavy, prolonged periods, infertility, and pelvic pain.

Sonographically:

1. Enlarged uterus, w/ lobulated contour that may indent the bladder, If the bladder volume is small, document the size. Frequency is common complication of fibroids because they reduce bladder capacity.
2. Focal ovoid or circular masses w/i the uterus; These may have a similar echogenicity to the remainder of uterus, but tissue w/i is organized in a whirled fashion. Blood vessels form a rim around fibroid, whereas with other rentities they may look similar , such as focal adenomyosis, the blood vessels traverse the lesion
3. The fibroid may be surrounded w/ a rim of calcification that can occasionally be so dense that the center cannot be seen w/ US
4. The relationship of fibroid to endometrial cavity should be defined. Submucosal fibroids that border on the endometrial cavity, often cause frequent lengthy periods w/ intramenstrual spotting and can cause infertility
5. Fibroids that lie w/i the cavity (intracavitary) or protrude into the cavity are even more likely to cause vaginal bleeding and cramping
6. Fibroids that have a small neck and extend off the border of the uterus are termed “pedunculated” they may be hard to distinguish from adnexal masses and may twist and infarct ( torsion). It should be possible to track the myometrial arteries into the pedunculated fibroid w/ color flow. Pedunculated fibroids w/ a small neck connecting them to the main part of the uterus may otherwise be mistaken for a solid adnexal mass
7. If the fibroid is acutely tender “red degeneration” may have occurred. There is usually a cystic center to the fibroid, the site of bleeding, when red degeneration has occurred.
8. Occoasional fibroids contain fat and are known as “Lipoleiomyomas” these masses are densely echogenic and circular but without shadowing
9. Patients w/ fibroids may need serial ultrasound at intervals. Rapid growth w/ an abrupt change in size can suggest malignancy. Exceedingly rare.

Answer 1

Fibroid

Question 2

Why is it important to document the bladder volume if it seems small when it pertains to fibroids?

Answer 2

Sometimes the fibroids reduce bladder capacity

Question 3

Which type of fibroids can cause lengthy periods w/ intramenstrual spotting and infertility?

Answer 3

Submucosal

Question 4

What is the difference between adenomyosis and fibroids when it comes to the vessels?

Answer 4

In focal adenomyosis, the blood vessels travel tranverse the lesion whereas in fibroids the blood vessels form a rim around fibroid

Question 5

Which type of fibroids cause vaginal bleeding?

Answer 5

Intracavitary Fibroids

Question 6

Why is it important to perform serial ultrasounds on fibroids?

Answer 6

Rapid growth w/ an abrupt change in size can suggest malignancy

Question 7

Endometrial glands invade the myometrium and respond to hormonal stimulation in the same fashion as the endometrial lining, causing cramping, heavy bleeding (menorrhagia) and uterine enlargement.

Sonographically:

1. Cysts of varying sizes may be found within the myometrium usually located close to endometrium
2. Subtle, more or less parallel echogenic lines radiate from the endometrium into myometrium.
3. The uterus is eccentrically enlarged usually with anterior aspect more enlarged than posterior
4. Myometrium has a patchy appearance, forming a “Donegal tweed” like pattern
5. Focal form, ill-defined echopenic mass is found. Blood vessels traverse the lesion, unlike the findings w/ fibroids where blood vessels surround the mass.

Answer 7

Adenomyosis

Question 8

The MOST COMMON GENITAL TRACT MALIGNANCY IN WOMEN

-Peak age for this is in the fourth decade. Often the lesion is too small to be seen with ultrasound, even if Pap smear is suggestive or it can be seen w/ a speculum exam.

Sonographically:

1. Bulky cervix with irregular outline, possibly extending into vagina or peritoneum
2. Mass extending from cervix to pelvic sidewalls.
3. Obstruction of the ureters, producing hydronephrosis
4. Invasion of bladder producing an irregular mass effect on bladder wall
5. Para-aortic node formation and metastatic lesions in liver

Answer 8

Cervical Cancer

Question 9

Why can cervical cancer cuase hydronephrosis?

Answer 9

There is an obstruction of the uterers

Question 10

A uterine cavity that contains echopenic fluid surrounding the myometrium.

-Especially when significant debris or gas forming organisms are present, echogenic areas w/ shadowing may occur

Answer 10

Pyometra

Pyo-Pus

Question 11

Distention of the vagina and uterus with fluid;

2nd to cervical or vaginal obstruction; a common cause is an imperforate hymen.

Often only the vagina is distended (hydrocolpos) and the uterus is still small; however, both the uterus and vagina may be fluid filled. The fluid contents are usually anechoic.

Answer 11

Hydrometrocolpos

Question 12

• Occurs when the vagina and possibly the uterus are distended with blood at menarche, rather than the serous fluid of hydrometrocolpos.
• Internal echoes within the blood are usually seen. Either the hymen is imperforate or there is a congenital septum blocking the vagina or cervix, which only becomes clinically apparent when menstruation starts.
• Hematometra, in which only the uterus is distended with blood, may be seen at menarche if there is a congenital occlusion of the vagina or cervix. In older women, it may result from cervical malignancy or post-radiation cervical stenosis.

Answer 12

Hematometrocolpos (premenarche)

Question 13

What is the main difference between hematometrocolpos versus hydrometrocolpos?

Answer 13

HEMATOmetrocolpos-the uterus and vagina are filled with BLOOD whereas with HYDROmetrocolpos, those areas are filled with FLUID.

Question 14

distention of the uterus with pus- usually occurs secondary to a cervical obstruction of drainage of the normal uterine secretions, with subsequent superinfection. The patient is febrile and very sick. Debris is seen within the fluid in the endometrial canal.

Age group??

Answer 14

Pyometra

Reproductive or postmenarche age groups

Question 15

In the proliferative phase, what should the endometrium measure?

Answer 15

0.2 to 0.4

Question 16

In the secretory phase, what should the endometrium measure?

Answer 16

0.8 to 1.3 cm

Question 17

Small masses such as polyps or intracavitary fibroids can be concealed in the _____________ phase

If possible, schedule patients w/ possible intracavity masses for the _______ stage or repeat study at that time

Answer 17

secretory phase

Question 18

Why is it important to correctly image uterine anomalies??

How many cavities should be demonstrated?

Answer 18

]\With uterine anomalies such as bicornuate and double uterus, the 2nd horn may be mistaken for adjacent mass.

Careful longitudinal and oblique scanning should demonstrate 2 endometrial cavities.

Question 19

With a double uterus, two _____ and a ______ will be present?

(female anatomy)

Answer 19

2 cervices and 1 vagina

Question 20

2. On a transabdominal view, the fundus of the retroverted uterus may be difficult to delineate if the beam lies at the same angle as the uterus. When acutely retroverted, the fundus may lie adjacent to the cervix and stimulate a mass. Because a retroverted uterus is globular in shape, enlargement is hard to assess. A fibroid may be mistakenly diagnosed unless Endovaginal views are obtained

(no answer, just study this)

Answer 20

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