Chapter 40: Sonographic & Doppler Eval of Female Pelvis Flashcards
The Doppler measurement that takes the highest systolic peak minus the highest diastolic peak divided by the highest systolic peak is what?
Pourcelot Resistive Index
What are the small vessels found along the periphery of the uterus?
arcuate vessels
What is a horizontal plane through the longitudinal axis of the body to image structures from anterior to posterior?
coronal
What is the pulsatility index?
the Doppler measurement that uses peak systole minus peak diastole divided by the mean over one cardiac cycle
The endometrium is at its greatest thickness and echogenicity with posterior enhancement in which phase?
secretory
The difference between the peak systole and the peak diastole is what?
S/D ratio
To image the fundus with TV, how do you angle the handle?
towards the bed
With EV sonography, the cervix of an anteverted uterus is seen to the _______ of the screen, while the fundus is seen to the ________ of the screen.
right, left
Which plane should the endometrium be measured in?
longitudinal
How long should a TV transducer be soaked in disinfectant between uses?
10-20 minutes
Symmetrical bilateral pelvic masses are likely to be what?
pelvic muscles
The thin outer layer of the uterus is separated from the intermediate layer by what?
arcuate vessels
Flexion refers to the axis of the uterine body relative to the
cervix
Nabothian cysts are found where?
endocervical canal
Arcuate artery calcifications are observed in what patients?
postmenopausal and diabetic
What technique is the best way to measure the cervical-fundal dimension of the uterus
transabdominal
Sonohysterography is usually performed on premenopausal women between days _____-____ of the menstrual cycle.
6-10
After soaking a transvaginal transducer in Cidex, what do you do?
rinse in water
What are a few contraindications for TV U/S?
- age of patient
- patient discomfort
- patient refusal
When a mass is found with U/S, what features should be characterized?
- location (intra or extrauterine)
- size
- external contour
- internal consistency
With a retroverted uterus, which side of the screen would show the cervix?
left side, fundus on right
For TV, when the probe is rotated 90 degrees from saggital plane, image orientation represents what?
coronal plane
Movement of the TV transducer is centered around what?
introitus
Describe the sections of the obturator internus muscle how they appear sonographically
seen at the posterior lateral corners of the bladder at the level of the vagina and cervix..muscle is hypoechoic and ovoid
The levator ani muscle is best visualized how?
In the transverse plane with caudal angulation at the most inferior aspect of the bladder…it is hypoechoic, hammock-shaped area that is medial, caudal, and posterior to the obturator internus
Where are the coccygeus and piriformis muscles located?
deep, cranially, and posteriorly
What is the most common muscle to be mistaken for the ovary?
piriformus muscle
Describe the uterine artery’s Doppler waveform
high velocity, high resistance characteristics but this varies with the menstrual cycle
What vessels can be used as landmarks for the lateral pelvis and ovary
internal iliac vessels
Where is the internal iliac vessel commonly seen?
lateral and deep to ovary
Describe the ovarian artery Doppler typical to the follicular phase
low velocity, high resistance
When does the resistance in the ovarian artery on the side with the dominant follicle drop dramatically?
during the periovulatory or luteal phase..then it rises during the late luteal phase
At the time of ovulation, what happens to velocity and RI?
both velocities increase and the RI decreases
What are echogenic foci in the inner layer of the myometrium, which are usually nonshadowing thought to represent?
dystrophic calcification related to previous instrumentation
Cervical inclusion cyst AKA
nabothian cyst
What is the size and shape of the uterus related to?
age, hormonal status, and parity
Prepubertally the cervix occupies how much of the uterine length?
2/3
How large is the uterus prepubertally?
1-3cm in length, 0.5-1cm in width
Describe the nulliparous cervix?
occupies 1/3 of uterine length
Describe the nulliparous uterine size
6-8cm in length and 3-5 cm in width
Describe the multiparous uterine size
an aditional 2cm in each direction from nulliparous
How much of the uterine length does the postmenopausal cervix occupy?
2/3
Describe the size of the postmenopausal uterus
3-5cm in length and 2-3 cm in width
Which method is best for imaging endometrium?
TV
Describe how the endometrial canal looks sonographically?
thin echogenic line as a result of specular reflections from the interface between the opposing surfaces of the endometrium
How does the endometrial canal appear during menstruation?
hypoechoic central line representing blood and tissue
Which endometrial phase corresponds to the 3 line sign
proliferative phase (late)
T/F: fluid in the endometrial cavity should be included in the endometrial measurement?
False
How may an infant’s endometrium appear?
thick and echogenic
During childbearing years, what is the range of endometrial thickness?
4-14mm
During menopause what happens to the endometrium?
becomes atrophic because no longer under hormonal control
Describe the postmenopausal endometrium without a hormone regimine?
a thin echogenic line measuring less than 8mm
What is the normal cut-off measurement for a nonhormonally stimulated endometrium postmenopausally?
4-10mm
When should patients be seen for further evaluation postmenopausally?
postmenopausal bleeding and endometrial double-layer thickness greater than 5mm
Where are ovaries located compared to the internal iliacs?
antermedial
Endovaginally, which plane is best to find the ovaries?
transverse
Describe the ovaries during the proliferative phase?
many follicles may develop and increase in size until day 8 or 9 of the menstrual cycle
Following ovulation, what happens within the ovary if no fertilization?
corpus luteum develops
How do corpus luteum cysts appear sonographically?
unilocular, anechoic structures with well-defined thing walls and posterior enhancement
What is the best marker for ID an ovary?
seeing a follicular cyst
Normal range for Graafian follicle?
1.8-2.4 cm
What is the best method for determining ovarian size?
volume
How is ovarian volume calculated?
0.523 X length X widthX thickness
A difference in size of one ovary greater than twice the volume of the contralateral ovary is considered
abnormal
What is recommended for postmenopausal women with cysts greater than 5 cm and for those who have cysts containing septations or solid nodules in the ovaries?
surgery
Focal calcifications in the ovary are thought to be
a stromal reaction to previous hemorrhage or infection..followups suggested to rule out neoplasm
What is frequently the initial site for intraperitoneal fluid?
posterior cul-de-sac
Why is sonohysterography used?
when the endometrium exceeds the normal thickness or shows focal areas of thickness for the patients clinical picture
Hope this quiz is easier than last weeks!!
prolly wont be tho :(
