female pelvis Flashcards
what passively develops into female organs?
paramesonepheric duct (mullerian duct)
paramesonepheric ducts develop into? (4)
- fallopian tubes
- uterus
- cervix
- upper vagina
lower part of vagina develops from the?
urogenital sinus
Development of the Ovary?
Ovaries – dual function
Gonads – contain egg cells (oocytes)
Endocrine glands - produce hormones
- There are several million oocytes in a developing ovary
- By birth 1 million left
- By menarche less than half million left.
Neonatal pelvis is examined for three main reasons?
- pelvic/abdominal mass
- ambiguous genitalia
- prenatally detected abdominal/ pelvic cyst
young girls reason for sono exam?
- vaginal bleeding
2. pelvic pain or mass
neonate- 6 years old ovarian volume?
1.0ml
6-11 years ovarian volume?
up to 2.5ml
after puberty ovarian volume?
up to 10ml
neonate female pelvis?
- endometrium is prominent
- follicles >9mm
Ovaries and uterus are larger in a newborn compared to 1-2 yrs old girls T or F?
true
neonatal uterus fundus/cervix ratio and shape?
ratio: 1:2
shape: spade
prepubertal uterus fundus/cervix ratio and shape?
ratio: 1:1
shape: tubular
pubertal uterus fundus/cervix ratio and shape?
ratio: 3:1
shape: pear
Pathology of Pediatric Pelvis? (5)
Uterine malformations Genital tract obstruction Pediatric Pregnancy Ambiguous genitalia PID
3 uterine malformations?
- arrested development of mullerian ducts
- failure of fusion of millerian ducts
- failure of reasoption of median septum
arested development of MD 2 catagories?
bilateral: uterine agesnisis/ hypoplasia
unilateral: uterus unicornis unicollis
bilateral arrested development?
agenesis:
- Mayer-Rokitansky-Kuster-Hauser syndrome
– complete agenesis of uterus and vagina
Hypoplasia:
- symptoms vary by a degree of hypoplasia
unilateral arrested development s/s?
Uterus unicornis unicollis:
- One mullerian duct fails to develop
- Rudimentary horn may be present
- Poor pregnancy outcomes
2 categories of failure of fusion of MD bicornuate uterus?
complete
incomplete
complete failure of fusion
complete failure of fusion of MD bicornuate uterus involves?
- uterus didelphys
- 2x uterus, cervix, vagina, endometrium
incomplete failure of fusion of MD bicornuate uterus involves?
- uterus bicornis bicollis
- uterus bicornis unicollis
- uterus arcuatus
failure of fusion of MD is associated with?
vaginal septa (25%)
complete failure of fusion of MD?
Didelphys:
- Two hemiuteri
- No communication with other side
- Each side has tube, ovary, endo, upper vagina
incomplete Failure of Fusion of MD?
- U. bicornis bicollis
- U. bicornis unicollis
- Arcuate U.
- Mild indentation of endo at fundus
- Poor pregnancy outcomes.
failure of resorption of median septum?
duplication of the uterine cavity without duplication of the horns
- complete uterus septus
- incomplete uterus subseptus
what is failure of resorption?
- complete fusion of MD
- median septum fails to resorb
- 2 uterine cavities form
- most common malformation of uterus
- poor pregnancy outcomes
- treatment: resection of septum
U. unicornis unicollis
reasons for genital tract obstruction? (3)
- imperforate hymen
- transverse vaginal septum
- vaginal atresia or stenosis
Genital tract obstruction can result in? (6)
Hydrocolpos Hydrometracolpos Hematocolpos Hematometracolpos Pyocolpos Pyometracolpos
Hydrocolpos?
- Premenstrual vaginal secretions trapped
SONO:
- large distended anechoic vagina
- Fluid can become infected -pyocolpos (pus)
Hydrometrocolpos?
extension of hydrocolpos to uterine cavity
Hematometrocolpos?
- After puberty, blood in the endo and vagina
- If infected -pyometracolpos
genital tract obstruction clinical presentation?
Neonates present with an abdominal mass
After puberty - amenorrhea and cyclical pain
genital tract obstruction sono?
- Pear-shaped cystic mass arising out of the pelvis containing fluid
- Hydronephrosis due to obstruction from the mass
Pediatric Pregnancy?
Must always be considered in the differential diagnosis of a pelvic mass in girls 9 years of age or older
pediatric pregnancy increased complications? (5)
Toxemia Preeclampsia Placental abruption Cesarean section Prematurity and perinatal mortality
definition of Ambiguous Genitalia?
If a child born with a micropenis with no palpable gonads or only one palpable gonad
- one of the main indications for US of neonate
Ambiguous Genitalia- role of ultrasound?
- Determine the presence of the uterus
- The presence of the uterus and ovaries will point to a virilized female
- Identify the gonads.
- The presence of testis palpable and seen in the scrotum or lower inguinal canal will rule out virilazation of female infant
- R/o CAH and renal anomalies
what is Pelvic Inflammatory Disease ?
infection of the upper genital tract usually caused by gonorrhea or chalmydia
Pelvic Inflammatory Disease can result in?
- chronic pelvis pain
- ectopic pregnancy
- infertility
whats at higher risk for Pelvic Inflammatory Disease ?
- adolescent females
- sexually active females presenting with pelvic pain
Pelvic Inflammatory Disease infections spreads from?
vagina-cervix-uterus-fallopian tubes-ovaries-peritoneal cavity
PID endometritis stage- sono findings?
- Pelvic anatomy appears normal or
- Uterus may be enlarged, more
hyperechoic, small amount of fluid in the endometrial canal - fallopian tubes (not usually seen) become thick-walled and filled with purulent material
PID pyosalpinx sono features?
dilated, occluded tube that contains purulent material
PID hydrosalpinx sono features?
dilated tube with anechoic fluid
A complication of PID?
gonococcal or chlamydial perihepatitis (localized peritonitis)
hematocolpos
ambiguous genitalia
higher incidence of larger cysts is mother had?
- toxemia
- diabetes
- Rh isoimmunization
4 types of cysts?
- follicular
- corpus luteal
- theca lutein
- paraovarian
what is a follicular cyst?
clear or serous fluid
what is a corpus luteal?
- serous or hemorrhagic fluid
theca lutein cyst is caused by?
- GTD or
- clomiphene/ clomid
what is a paraovarian cyst?
- rare
- in broad ligament or fallopian tubes
ovarian cysts: complications?
- torsion
- hemorrage
- rupture
ovarian cysts symptoms?
- pain
- tenderness
- N & V
what is torsion?
- partial or complete roatation of the ovary on its vascular pedicle
- compromised arterial and venous flow
- hemorrhagic infarction
torsion is often caused by?
- ovarian cyst or tumor
- prepubertal girls can be predisposed (excessive mobility of the adnexa)
torsion symptoms?
- acute onset of abdominal pain
- N & V
- leukocytosis
torsion on ultasound?
- unilateral ovarian enlargement
- fluid in PCDS
- cyst or tumor
- twisted vascular pedicle
absence of flow is a reliable criteria for torsion T or F
False- it is not a reliable source
target or whirlpool sign on doppler is associated with?
torsion
- twisted vascular pedicle
ovarian torsion
hemorrhagic cyst
hemorrhagic cyst on u/s?
- heterogenous mass
- anechoic with hypoechoic material
- increased TT
- thick walls
- septations
- fluid in cul-de-sac
PCOD aka?
stein-leventhal syndrome
PCOD clinical features?
- hirsutism
- irregular menstrul bleeding
- associated with obesity and diabetes
- high incidence of endoetrial carcinoma
- infertility
PCOD on u/s?
- bilateral enlarged rounded ovaries
- ovarian vol.= 14cc
- increased number of developing follicles (0.5-0.8cm)
PCOD
most ovarian neoplasms occur when?
most occur at puberty
ovarian neoplasms usually present with?
- abdominal pain
- abdominal or pelvic mass
- pain from torsion or hemorrhage
- pain from torsion or hemorrhage into tumor
ovarian neoplasms usually present with?
- abdominal pain
- abdominal or pelvic mass
- pain from torsion or hemorrhage
- pain from torsion or hemorrhage into tumor
ovarian neoplasm with acites?
- ascites is less common than in adults
- presence of ascites suggests malignancy
ovarian neoplasms- role of sonographer?
- site of orgin
- solid/ cystic
- fluid in POD
- ascities
- lymphadenopathy
- mets
3 primary ovarian neoplasms?
- germ cell
- epithelial cell
- stromal cell
germ cell tumors? (5)
Benign teratoma Dysgerminoma Embryonal carcinoma Endodermal sinus tumors Choriocarcinoma
epithelial cell tumors? (3)
Serous cystadenoma
mucinous cystadenoma
serious cystadenocarcinoma
mucinous cystadenocarcinoma
stromal cell tumors? (3)
Granulosa theca cell tumor
Arrhenoblastoma
Gonadoblastoma
Mets (non-primary) ovarian neoplasms?
- leukemia
- lymphoma
- neuroblastoma
- colon cancer
germ cell tumors- benign teratoma sono apperance?
- Predominantly cystic with or without mural nodule
- Solid masses
- Complex lesions with fat-fluid or hair-fluid levels
- Calcifications
benign teratoma
what is Dysgerminoma?
Malignant
Large, solid, encapsulated
Rapidly growing
Hypoechoic areas from hemorrhage, necrosis
Embryonal carcinoma, Endodermal sinus tumors, and Choriocarcinoma
Less common
Rapidly growing
Highly malignant
Solid
Spread by direct extension to opposite adnexa and retroperitoneal LNs
Cause peritoneal seedings, mets to liver, lung, bone, mediastinum
granulosa theca cell tumor?
- Associated with feminizing effects and precocious puberty (estrogen producing)
- Most are benign
- Solid, non-specific US appearance
Arrhenoblastoma may result in?
- rare
- may result in virilazation
gonadoblatoma?
- most are benign
- composed of gonadal elements (germ, stromal, and sex cord cells)
Neoplasms of uterus and vagina?
- Uncommon in children
- If present, more likely malignant
- Vagina is more common site than uterus
types of neoplasms of the uterus and vagina?
- rhabdomyosarcoma
- endodermal sinus tumor
- carcinoma of vagina
endodermal sinus tumor?
- highly malignant gern cell tumor of vagina
what is carcinoma of the vagina from?
- from in utero exposure to DES
what is Rhabdomyosarcoma?
- Malignant
- Arise from uterus or vagina
- Most often from anterior wall of vagina near cervix
- May directly extent to bladder
clinical presentation of Rhabdomyosarcoma?
- 6-18 months old
- vaginal bleeding
- protrusion of polyploid cluster of masses
Rhabdomyosarcoma on u/s?
- solid tumors
- homogenous mass that filled the vaginal cavity
- enlargeent of uterus with irregular contour
Rhabdomyosarcoma
Endocrine abnormalities with primary amenorrhea? (4)
- Gonadal dysgenesis (m/c form – Turner’s syndrome)
- Chromosomal abnormalities
- Decreased hormonal states
- Testicular feminization
Endocrine abnormalities with primary amenorrhea role of sonographer?
- assess uterine size, shape, maturity
- ovarian development
Turner’s syndrome?
- 45, XO karyotype
- Delayed or absent puberty
- Short statue, webbed neck
- Renal and CV problems
turner’s syndrome on u/s?
- ovaries may not be seen
- streak ovaries
- prepubertal uterus
Testicular feminization?
- Sex-linked recessive abnormality
- End-organ insensitivity to androgens
- Phenotypic females with 46,XY karyotype
- Absent uterus and ovaries
- Ectopic testes
Endocrine abnormalities: Precocious Puberty?
- Development of secondary sexual characteristics, gonadal enlargement, & ovulation before age 8 yrs
Endocrine abnormalities: Precocious Puberty clinical presentation?
- Uterus enlarged with postpubertal shape
- fundus/cx ratio - 2:1 to 3:1
- Prominent endometrium
- Ovarian volume > 1cc, with functional cysts
percocious puberty- central type?
- true precocious puberty
- gonadotropin dependent
- increases FSH, LH, and estrogen
causes of percocious puberty- central type?
- idiopathic
- intracranial tumor
percocious puberty- peripheral type?
- pseudoprecocious puberty
- gonadotropin independent
- increased estrogen
- decreased FSH, LH
causes of percocious puberty- peripheral type?
Ovarian tumor
Granulosa techa cell tumor
Dysgerminoma
Choriocarcinoma
