FEMALE REPRODUCTIVE PATHOLOGY AND IMAGING TECHNIQUE Flashcards
WHAT IS THE ADVANTAGE OF USING ULTRASOUND FOR FEMALE REPRODUCTIVE IMAGING?
- No radiation
- Non invasive
- Cheap / Quick
- Easily Available
- Reproducible
- Measurements
- Relationship to other structures
- Instant results
- Localisation of lumps
- Biopsy guidance
- Pregnant patients
- Well tolerated
- Good soft tissue detail
- Can examine moving structures
WHAT IS THE DISADVANTAGE OF USING ULTRASOUND FOR FEMALE REPRODUCTIVE IMAGING?
- Operator dependant
- No Functional information
- Can’t image gas / air filled structures
- Bones get in the way
- Patient habitus
- Requires prep
WHAT ARE THE REASONS THAT ULTRASOUND OF THE FEMALE PELVIS TAKEN?
- Unusual pain or bleeding
- Infertility
- Menstrual problems- absent, late, heavy
- Confirmation of a Pelvis mass found during clinical exam
HOW DOES THE ENDOMETRIUM CHANGE THROUGHOUT THE MENSTRUAL CYCLE?
- Day 1-4- Menstruation
May see fluid in the cavity - Days 5-8 Early proliferative phase
Very thin echogenic line - Days 9-15 Follicular phase
Becomes thicker
3 line sign
Ovulation occurs - Days 16-28 Luteal phase
thickest
WHAT IS THE TRANSABDOMINAL APPROACH(ULTRASOUND)?
- Normal eating and drinking
- No need to change
- Full bladder
- Moves bowel out of the FOV
- Acoustic window
- Useful anatomical landmark
- Manipulates the position of the uterus for it to be visualised.
WHAT IS THE TECHNIQUE FOR TRANSABDOMINAL APPROACH (ULTRASOUND)?
ANATOMY INCLUDED: Uterus, Endometrium, Ovaries and Adnexae
- Positive ID
- Explanation
- Consent
- Privacy
- Previous results
- Question patient
- Patient - supine
- Protect clothes
- Survey scan in Longitudinal & Transverse sections
- Detailed scan
- Consider if TV is required
- Clean off gel
- Toilet
Results
WHAT IS THE ADVANTAGE OF TRANSABDOMINAL APPROACH (ULTRASOUND)?
- Large FOV
- Visualise relationship with other organs
- Can image large masses
- Can image other areas
- Assess bladder
- No chaperone
- Non invasive
- Measurements
WHAT IS THE DISADVANTAGE OF TRANSABDOMINAL APPROACH (ULTRASOUND)?
- Limited Resolution
- Small lesions
- Uncomfortable full bladder
- Longer to fill
- Retroverted uterus
- Endometrial thickness not as accurate
WHAT IS THE PATIENT’S PREPARATION FOR A TRANSVAGINAL SCAN (ULTRASOUND)?
- Empty bladder
- Normal eating and drinking
- Undressed from the waist down
- Consent
- This is more invasive then TA
- Patient privacy and dignity - Chaperone
- For the radiographer and the patient
WHAT IS THE TECHNIQUE FOR TRANSVAGINAL APPROACH (ULTRASOUND)?
- Positive ID
- Empty bladder
- Explanation
- Consent
- Chaperone
- Privacy
- Allergies
- Previous results
- Question patient
- Cover probe and gloves
- Aqueous gel
- Patient undressed
- Probe insertion - scan
- Results
WHAT ARE THE ADVANTAGES OF TRANSVAGINAL SCANS (ULTRASOUND)?
- Higher frequencies - better resolution
- No full bladder
- Quicker scanning time
- Improved visualisation
- Retroverted uterus (wont be able to see this on TA)
- Obese patients
- Chaperone
WHAT ARE THE DISADVANTAGES OF TRANSVAGINAL SCANS (ULTRASOUND)?
- Chaperone
- Patient acceptance
- Invasive
- Uncomfortable
- Smaller FOV
- Cross infection
- Unable to assess elsewhere
- High positioned masses/ovaries
- Contraindications
PATHOLOGY: FIBROID
- Benign muscle tumour
- 35 + years old
- Can be asymptomatic
- 10cm> bowel or renal symptoms as compressing these structures. - May grow during pregnancy
- Due to increased oestrogen - Decrease in size during menopause
- Due to reduced hormones - Patient present with heavy painful periods
Heavy periods because the fibroid pushes into the uterus and causes an increase in the surface area of the endometrium which leads to more tissue to then be shed during menstruation.
From a treatment perspective, these patients have several options including:
- leaving them to decrease in size naturally at menopause
- Having them removed surgically
- Having them embolised in interventional radiology- this will remove the blood supply to the fibroid so that it shrinks.
APPEARANCE OF ENDOMETRIUM
- Important to know exact stage in menstrual cycle as can get false results.
- thicken endometrium can give the appearance of:
- Polyp
- Carcinoma
- Hormone imbalance
- Affects of medication - thinned endometrium can give the appearance of:
- Hormone imbalance
- Post menopausal
- Oral contraception
- Absence of periods
PATHOLOGY: ENDOMETRIAL POLYPS ON ULTRASOUND
- Polyps grow
- Do not undergo malignant transformation
- Bleeding and spotting between periods
- Problems getting pregnant
Polyps are treated by removing them as a day case.
Once treated can often lead to a successful pregnancy
PATHOLOGY: ENDOMETRIAL CARCINOMA
Post menopausal- 40-70
Obesity- hormonal imbalance
Abnormal bleeding
Pain during intercourse
Back, leg and pelvic pain
On Ultrasound they appear:
- Irregular
- Heterogenous
- Thick walled
