Female Pelvis Breakdown And Vascularity Flashcards
What is S/D ratio?
Peak systole/end diastole ratio
How do you distinguish between a vessel and a cyst when scanning?
Use color Doppler or pulsed Doppler display
What is RI?
Resistive Index
Peak systole
What is PI?
Pulsatility Index
Mean
How are arteries and veins positioned in the body?
Arteries are usually anterior to veins
Where are the iliac vessels located?
In the lateral pelvis
Where are the uterine vessels located?
Lateral to cervix
LUS at level of internal so
What is the RI of the uterine vessels in a non pregnant uterus?
RI .88
The vagina has how many sources of blood?
2
When dealing with the vagina, what does a branch of the uterine artery supply?
Anterior surface of the vagina and the cervix
When dealing with the vagina, what does a branch of the internal iliac vessel supply?
Posterior surface of the vagina
The RI of the ovaries ________ throughout the menstrual cycle.
Varies
Describe resistance and velocity during the follicular phase.
High resistance
Low velocity
During ovulation, describe velocity and RI. What is RI of corpus luteum?
Max velocity higher
RI decreases
.44 or lower impedance in corpus luteum
What is the RI of a post menopausal ovarian artery? Describe diastole flow.
.94
No diastole flow evident after 5 years into menopause = RI 1.0
What are the layers of the uterus?
Serosa
Myometrium
Endometrium
Describe uterus serosa.
Not visualized sonographically
Outer layer
Describe uterus myometrium.
Middle muscle layer
Homogeneous smooth walled borders
Arcuate arteries may have calcification
Describe uterus endometrium.
Inner layer
Thin hypovascular
Contains spiral arteries
Describe the location of the internal os of the cervix.
Body of uterus separated from cervix by isthmus
Describe the cervical canal.
Homogenous
Echogenic central line
May contain cysts
What type of cysts are found in the cervix and what are their sizes?
Nebothian cysts
1-2 cm
How can the true lie of the uterus be visualized?
Endovaginally
How will an anteverted uterus seen on the screen?
Fundus to left of screen
Cervix to right of screen
How is a retroverted uterus seen on the screen?
Cervix to left of screen
Uterus to right of screen
How is the endometrium seen best?
Endovaginally
Menstruation days and endo size?
Days 1-4
Hypoechoic line 4-8 mm
Early proliferative phase days and endo size?
Days 5-9
6 mm
Late proliferative phase days and endo size?
Days 10-14
10 mm when ovulation occurs
Secretory (luteal) phase days and endo size?
Days 15-28
7-14 mm
What doesn’t get included even measuring the endometrium?
Fluid
Endometrium size during childbearing years is what?
4-14 mm normal
Post menopausal endo size?
Less than 8 mm
Post menopausal with HRT endo size?
Up to 14 mm
At what size should the endo have additional evaluations?
If greater than 5 mm
Can you see the Fallopian tubes?
Usually no
What is the size of the Fallopian tubes?
8-10 mm
How can you find the Fallopian tubes when scanning?
Follow laterally from cornua to ovaries
What does an abnormal Fallopian tube look like?
Tortuous tubular structure
How do the ovaries normally lie within the pelvis?
Laterally to uterus and anteromedial to iliac vessels
Describe the ovoid medium level.
Echogenic structure with follicles
Describe a Graafian follicle.
Day 14 dominant follicle
2 - 2.5 cm
What happens after ovulation?
Corpus luteum develops
What is the normal ovary volume during premenarch?
3-8 cm cubed
What is the normal ovary volume during menarch?
9.8-21.9 cm cubed
What is the normal ovary volume during postmenopausal?
5.8-8 cm cubed
What is the measurement of normal follicles?
Less than 3 cm
Describe postmenopausal cysts.
Greater than 5 cm with septations or nodules should be removed
Describe inclusion cysts.
Echogenic nonshadowing foci
1-3 mm
Normal cysts
Describe focal calcifications.
Stromal reaction
Previous hemorrhage or infection
Need f/u or r/o early neoplasm
What is another name for the posterior cul de sac?
Pouch of Douglas
Are small amounts of fluid in the cul de sac normal?
Yes
When should fluid in the cul de sac be a concern?
Large amounts of fluid
Debris or septated fluid
How is bowel seen while scanning?
Dirty shadow
Fluid filled with peristalsis
Other names for a sonohysterography…
Saline infused sonography
Hysterosonograghy
What does a sonohysterography evaluate?
Thickness of endometrium to r/o a polyp or mass
How is a sonohysterography done?
Insert sterile speculum Catheter is inserted Speculum is removed TV probe is inserted 10-15 cc sterile saline is inserted
What is 3 dimensional imaging called?
Volume imaging
What does volume imaging evaluate?
Endometrium
What kind of imaging is demonstrated with 3D?
Coronal imaging
How is a volume image taken?
Press 3D/4D button
Will automatically sweep to image
Sonographer manipulates image to visualize endometrium canal
Line up dots with endo line in 3 different planes
