Extra Pelvic Pathology Flashcards
What is the hymen?
A septum that remains in the lumen of the vagina between urogenital sinus and upper vagina
Imperforate hymen occurs if what? What does it cause?
If the hymen does not rupture causing hydrocolpos or hematocolpos
Vaginal septum, congenital or acquired obstructive lesions can also cause what? 2
- Hydrocolpos
- Hematocolpos
What is hydrocolpos? 2
- Fluid in the vagina
- Retention of vaginal secretions
What is hydrometrocolpos?
Secretions in uterus and vagina
When can hydrocolpos and hydrometropcolpos take place?
Before menarche or after menopause
What is hematocolpos?
Blood trapped in the vagina
Hematometra is what?
Retention of blood in uterus
What is hematometrocolpos?
Blood in uterus and vagina
When does hematocolpos, hematometra, hematometrocolps occur?
After menarche, or before menopause
How do we spot hematocolpos sonographically? 3
- identify the level of obstruction
- Evaluate the echogenicity
- Look for fluid fluid levels
What are gartner’s duct cysts?
Cysts along the vagina
What is the gartner’s duct cysts a remnant of?
Mesonephric duct
How many gartner’s duct cysts can someone have?
Single or multiple
Gartner’s duct cysts are usually in which walls?
Lateral or anterolateral walls
How are gartner’s duct cysts found?
Incidentally
Are gartner’s ducts asymptomatic or symptomatic?
Asymptomatic
Are vaginal carcinomas used for diagnosis?
No
What is sonography used for in terms of vaginal carcinoma? 2
- Used to help stage
- Used to assess pelvic spread or distal metastasis
What are nabothian cysts in the cervix? 2
- Retention cysts
- Entrapped cervical secretions
How common is nabothian cysts?
Common
How many nabothian cysts do we have at one time?
Multiple
How do we diagnose carcinoma in the cervix?
PAP smear
Carcinoma of the cervix may cause what?
obstruction
What are cervical cancer risk factors? 8
- Infection by HPV
- Early sexual activity
- Multiple sexual partners
- Low socioeconomic status
- Smoking
- Use of Oral contraceptives
- Weakened immune system
- DES in utero
What are sonographic findings of cervical cancer? 8
- Hematometra from cervical stenosis
- Multiple cystic areas within a solid cervical mass
- Bulky cervix
- Irregular cervical boarders
- Mass extending from cervix to pelvic sidewall
- Tumor invasion of the bladder
- Hydronephrosis
- Liver Mets and para- aortic nodes
Incompetent cervix may cause what?
Preterm labor or delivery
In terms of incompetent cervix, cervical effacement happens when? (In pregnancy)
2nd or early 3rd trimester
What are causes of incompetent cervix? 3
- Trauma
- DES - t shaped uterus
- Idiopathic
What is the best way to assess incompetent cervix?
Translabial or transvaginal
What are some examples of Adenexal pathology? 2
- Endometriosis
- Pelvic inflammatory disease (PID) both acute and chronic
What is endometriosis?
Growth of endometrial tissue outside uterine cavity
What are the two types of endometriosis?
- Internal (Adenomyosis)
- External (Endometriosis)
Where does endometriosis occur? 4 (organs and locations)
- Ovaries
- Fallopian tubes
- Broad ligament
- Pouch of Douglas
Endometriosis only occurs in which age group?
Reproductive
What kind of transmission does endometriosis have?
Retrograde tubal transmission
Endometriosis can cause what?
Adhesions
Endometriosis are usually only diagnosed by what?
Laparoscopy
What are some symptoms of endometriosis? 7
- Dysmenorrhea
- Dyspareunia
- Infertility
- Menorrhagia
- Painful urination, defecation
- Chronic pelvic pain
- May have palpable mass (endometrioma)
How easy is it to DX endometriosis on u/s?
Difficult
What are some things to look for during endometriosis? 3
- Negative sliding sign
- Kissing ovaries
- Endometrioma
Why does endometriosis only affecting reproductive age group?
Because it is at this time that the endometrium is affected by hormones
What is negative sliding sign? 2
- With pressure, sliding of the uterus not observed
- Ovaries do not move with pressure
What is kissing ovaries?
Ovaries touching each other in the posterior cul de sac
How does endometrioma present? 4
- Well defined
- Predominately cystic ovarian mass
- Low level echoes
- May see fluid- fluid levels
What is another name for endometrioma?
Chocolate cyst
What is the DDX for endometrioma? 3
- Hemorrhagic ovarian cysts
- Ovarian cysts Adenoma
- Turbo-ovarian abscess
What are treatment options for endometriosis? 3
- Drug
- Hysterectomy and oophorectomy
- Laser surgery
What is pelvic inflammatory disease?
Infection of the female genital tract
What are the causes of Pelvic inflammatory disease? 2
- STI
- Pyogenic
What are 4 causes of pyogenic?
- IUCD
- Surgery
- Postpartum
- Crohn’s disease
How many stages of Pelvic inflammatory disease?
Three
What are the three symptom stages of pelvic inflammatory disease?
- Asymptomatic or vaginal discharge and tenderness (endometritis)
- Febrile, acute pelvic pain, abnormal vaginal bleeding. may develop hydrosalpinx
- TOA stage - acute ABD pain, increased WBC ma even develop fitzhugh Curtis syndrome
What is two things we see with fitzhugh Curtis syndrome? (S/S)
- Perihepatitis - inflammation of the liver capsule
- Small abscesses on liver capsule - may lead to adhesions
Where/how do we feel pain in fitzhugh Curtis syndrome? 2
- On inspiration
- RUQ pain
Fitzhugh Curtis syndrome may increase what?
Liver enzymes
How many patients with fitzhugh Curtis syndrome have PID?
5-10 have PID
What is scalpingitis?
Walls become thickened and edomatous
During salpingitis, if the tubes block what happens?
Pyosalpinx occurs
Once salpingitis is treated what happens to the affected material?
Infected material is reabsorbed and the chronic result is hydrosalpinx
What are the three stages of PID?
- Endometritis
- Pyosalpinx
- TOA
How many stages of acute PID?
3
How does endometritis during acute PID look like? 4
- Thick endometrium
- Fluid in endometrial canal
- Or normal endometrial canal
- Difficult to DX on US
What does pyosalpinx look like with acute PID sonographically? 2
- Hypoechoic S shaped fallopian tubes with low level echoes
- Fallopian tube walls are smooth
What does TOA look like with acute PID? 3
- Multiocular mass
- Irregularly boarders
- Fluid- fluid levels within mass, make sure the cystic loops do not move (bowel with peristalsis
What does chronic PID look like sonographically? 2
- Distended S shaped tubes
- Thin walls
What is the DDX for chronic PID?
Difficult to differentiate from ovarian cysts or small cystadenomas
What is the PID treatment method? 2
- Heavy doses of antibiotics
- Abscess drainage or salpingectomy
What is fallopian tube carcinoma?
Serous intraepithelial tubal carcinoma
What is fallopian tube carcinoma usually referred to as?
STIC
In terms of fallopian tube carcinomas, it is thought that many ovarian cancers begin where?
The fimbriae of the fallopian tubes
Most fallopian tube caricinomas are what type?
Adenocarcinomas
Minority of fallopian tube carcinomas are what?
Endometriosis and clear cell adenocarcinoma
What does tubal carcinoma look like sonographically? 5
- Very similar to ovarian cancer
- Complex, large solid mass with cystic components
- Highly vascular
- Sausage shaped
- Most cases ovary is not seen separately
Ambiguous genitalia is seen in how many cases of babies?
1 in 50,0000
Isolated occurrences of intersex occurs in how many?
1 in 1000 but more commonly associated with other anomalies
What is the sonographic evaluation of hermaphroditism/ intersex? 3
- Assess retroperitoneum and labia for gonads
- Assess pelvis for Müllerian structures
- Assess adrenal garlands and kidneys to exclude associated anomalies
What is a true hemaphrodite?
Possessing both male and female sex trait
What is a pseudohermaphrodite?
Possessing chromosomes of one sex but develop sex traits of the opposite sex
For hermaphroditism/ intersex what studies are run parallel to u/s? 2
Hormonal and chromosomal
What is a male pseudo hermaphrodite?
46XY, genetically male (testes) but have female characteristics (breasts, lack facial hair, and have underdeveloped external genitalia). May lack androgens
What is a female pseudo hermaphoraodite 46XX
Genetically female (ovaries) but have male characteristics (penis, scrotum, hirsuitism). May be due to excessive androgens or congenital adrenal hyperplasia (CAH)
What do we do with sonography with pelvic masses? 5
- Confirm the presence of a mass
- Determine where the mass is originating from
- Evaluate
- Demonstrate the involvement of other organs
- Document if ascites or other metastatic lesions are present
What do we evaluate with sonography with pelvic masses? 5
- Size
- Echogenicity
- Contour of the masses
- Vasculature
- Consistency
Remember to look beyond the pelvis if pathology is seen, what do we look at? 4
- Kidneys for obstruction
- Liver for metastatic disease
- Lymphadenopathy
- Free fluid/ ascites
What is this image represent?
Hematometra
What does this image represent?
Hematocolpos
What does this demonstrate?
Gartner’s duct cyst
What does this image demonstrate?
Nabolthian cysts
What does this image demonstrate?
Carcinoma of the cervix
What does this image demonstrate?
Kissing ovaries
What does this image demonstrate?
Endometritis or pyometritis
What does this image demonstrate?
Stage 2 pyosalpinx
What does this image demonstrate?
Tubo ovarian abscess
What does this image demonstrate?
Chronic PID on sonography