Diagnostic radiology: women imaging Flashcards

1
Q

What are the 2 basic views of mammography?

A

Craniocaudal (CC)
Mediolateral oblique (MLO)

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2
Q

What is the indication of breast US elastography?

A
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3
Q

What is the use of breast MRI?

A
  • High risk screening
  • Patient with breast augmentation
  • Detect occult cancer and evaluate disease extent
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4
Q

What features are observed for in mammogram for malignancy?

A

Tumour (mass, density)
- poorly circumscribed, irregular, spiculated, dense
Microcalcification
- irregular, pleomorphic sizes and density, linear,
clustered Retraction (distortion)

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5
Q

What are USG findings of breast malignancy?

A
  • Hypoechoic
  • Irregular mass
  • Vascularity
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6
Q

What are USG findings of breast mass (benign)?

A
  • Round or oval
  • No vascularity
  • Anechoic (breast cyst)
  • Hypoechoic (fibroadenoma)
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7
Q

Benefits and disadv of transvaginal/transabd ultrasound?

A
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8
Q
A
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9
Q
A
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10
Q
A
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11
Q
A
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12
Q

For pelvic pain what is first line imaging and other possible imagings done?

A

US: initial imaging investigation
MRI: useful in identifying gyne causes e.g. endometriosis, adenomyosis
CT: for non gynaecological cause

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13
Q

What imaging for pre-menopausal abnormal vaginal bleeding?

A
  • 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
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14
Q

What imaging for post-menopausal abnormal vaginal bleeding?

A
  • TVUS: recommended to assess endometrial thickness
  • Endometrial thickening ≥5 mm or abnormal morphology should be investigated by biopsy
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15
Q

What is sequence of imaging for suspected pelvic mass?

A
  • 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).
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16
Q

What is the imaging choices for gynecological cancers?

A
  • 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
17
Q

What is the imaging for infertility in woman?

A
  • 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
18
Q

What are the different mulleriaen duct anomalies?

A

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

19
Q
A

Uterus didelphys:
- 2 separate, non-communicating horns, 2 cervices
- Assess for concomitant renal anomalies

20
Q

Which is pre menopause and post menopause?

A
21
Q
A

MMG
* Skin thickening around nipple

Require tru-cut biopsy (molecular dx)

22
Q

Breast

A
23
Q
  • 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?
A

Mastitis, breast abscess
USG
Don’t do mammogram in young lady (compressed by 2 planes will be painful in infective cause)

24
Q

Painful breast mass with fever

A
  • 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
25
Q
A
26
Q
  • 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?
A

Endometriosis
Transvaginal (OG)/transabd ultrasound

27
Q
A

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
28
Q

If suspicious of endometrioma, what next investigation done?

A
29
Q

dx

A

Transabd ultrasound (as bladder in front)

if insure about dx do MRI

30
Q

54yo with large pelvic mass.

US showed a large pelvic mass with heterogeneous echogenicity, predominantly hypoechoiec
What do you suggest?

A

TVUS offers limited vision
do pelvic MRI

31
Q
A

90% epithelial in origin
* 15-30% lifetime risk in
BRCA 1 and 2 mutations
* Routes of spread:
* Local spread
* Peritoneal seeding*
* Lymphatics
* Haematogenous

32
Q
A

CT scan (bone is white)

33
Q
A