Diagnostic radiology: women imaging Flashcards
What are the 2 basic views of mammography?
Craniocaudal (CC)
Mediolateral oblique (MLO)
What is the indication of breast US elastography?
What is the use of breast MRI?
- High risk screening
- Patient with breast augmentation
- Detect occult cancer and evaluate disease extent
What features are observed for in mammogram for malignancy?
Tumour (mass, density)
- poorly circumscribed, irregular, spiculated, dense
Microcalcification
- irregular, pleomorphic sizes and density, linear,
clustered Retraction (distortion)
What are USG findings of breast malignancy?
- Hypoechoic
- Irregular mass
- Vascularity
What are USG findings of breast mass (benign)?
- Round or oval
- No vascularity
- Anechoic (breast cyst)
- Hypoechoic (fibroadenoma)
Benefits and disadv of transvaginal/transabd ultrasound?
For pelvic pain what is first line imaging and other possible imagings done?
US: initial imaging investigation
MRI: useful in identifying gyne causes e.g. endometriosis, adenomyosis
CT: for non gynaecological cause
What imaging for pre-menopausal abnormal vaginal bleeding?
- US: imaging of choice to exclude the presence of leiomyoma (fibroid), endometrial or adnexal abnormality
- If bleeding persists, gynaecological referral for hysteroscopic examination should be considered
What imaging for post-menopausal abnormal vaginal bleeding?
- TVUS: recommended to assess endometrial thickness
- Endometrial thickening ≥5 mm or abnormal morphology should be investigated by biopsy
What is sequence of imaging for suspected pelvic mass?
- US: recommended as initial evaluation to confirm the presence of pelvic mass and likely origin.
- MRI: indeterminate pelvic mass on US and for further characterisation.
- CT: reserved for staging pelvic mass with high probability of malignancy (skip MRI if there is ascites and other suggestive signs).
What is the imaging choices for gynecological cancers?
- US: often the initial evaluation to confirm the presence of pelvic malignancy
- MRI: local pelvic staging
- CT (or PET/CT): extra-pelvic staging for metastastic screening
What is the imaging for infertility in woman?
- US: assess pelvic congenital anomaly or pathology
- Hysterosalpingography (HSG): fluoroscopic evaluation of uterine cavity and fallopian tubes, assess tubal patency
- MRI: structural assessment if US suggests abnormality
What are the different mulleriaen duct anomalies?
A. Unicornuate uterus (20%)
- Single uterine horn; may have rudimentary horn
B. Uterus didelphys (5%)
- 2 separate, non-communicating horns
- 2 cervices
C. Bicornuate uterus (10%)
- Concave or heart-shaped external contour
- 2 horns with variable fusion
D. Septate uterus (55%)
- Normal external contour
- Septum may extend for variable lengths
- Complete (to external os) or partial
Uterus didelphys:
- 2 separate, non-communicating horns, 2 cervices
- Assess for concomitant renal anomalies
Which is pre menopause and post menopause?
MMG
* Skin thickening around nipple
Require tru-cut biopsy (molecular dx)
Breast
- 28-year old
- Recently given birth and breast-feeding
- 1-week history of painful right breast mass * Associated with fever
Differential Diagnosis?
Any imaging investigation that you wish to order?
Mastitis, breast abscess
USG
Don’t do mammogram in young lady (compressed by 2 planes will be painful in infective cause)
Painful breast mass with fever
- Heterogeneous, predominantly hypoechoic mass
- Fluid collection with thick wall
- Doppler: ↑ Peripheral vascularity
- Drainage can be arranged
- MMG not indicated in young woman with typical presentation
- 28-year old
- 2-3 years history of pelvic pain with menstruation * Nil others
- Exam unremarkable
Differential Diagnosis?
Any imaging investigation that you wish to order?
Endometriosis
Transvaginal (OG)/transabd ultrasound
Transvaginal ultrasound (no bladder which is required for imaging)
- Homogeneous, hypoechoic ovarian mass
- Uniform low-level internal echoes
- Thick wall ± echogenic foci
- Round shape
- Posterior acoustic enhancement
If suspicious of endometrioma, what next investigation done?
dx
Transabd ultrasound (as bladder in front)
if insure about dx do MRI
54yo with large pelvic mass.
US showed a large pelvic mass with heterogeneous echogenicity, predominantly hypoechoiec
What do you suggest?
TVUS offers limited vision
do pelvic MRI
90% epithelial in origin
* 15-30% lifetime risk in
BRCA 1 and 2 mutations
* Routes of spread:
* Local spread
* Peritoneal seeding*
* Lymphatics
* Haematogenous
CT scan (bone is white)
