Female reproductive system - abnormal Flashcards
How do we image the female reproductive system?
- Transabdominal or transvaginal ultrasound
What are the advantages and disadvantages of Transabdominal or transvaginal ultrasound?
Advantages
* Non invasive and painless
* No ionising radiation
* Real time imaging
* Portable and accessible
* Procedure guidance such
as biopsies
Disadvantages
* Operator dependent
* Limited penetration in
some patients
* Less accurate for bones or
air filled structures
How do we image the female
reproductive system?
CT
What are the advantages and disadvantages of CT for imaging the female reproductive system?
Advantages
* Accurate, detailed images
* Fast imaging – useful in
emergency situations
* Allows accurate
visualisation of complex
structures
Disadvantages
* Radiation
* Les detailed than MRI for
soft tissue differentiation
How do we image the female
reproductive system and what are the advantages and disadvantage?
Advantages
* Exceptional soft tissue
contrast – can differentiate
between different tissues
* Can see structures in
multiple planes
* No radiation – safe in
pregnancy
* Can provide functional
imaging
Disadvantages
* Time
* Cost
* Patient compliance
* Contraindications
Description of the uterus- normal variants
- Congenital uterine abnormalities
- Malformations of the uterus that
develop during embryonic life; occur in
less than 5% of all women and include: - Septate: a normal external uterine surface
but two endometrial cavities - Bicornuate: an abnormal, indented
external uterine surface and two
endometrial cavities - Arcuate: a normal external surface with
1cm or less indentation into the
endometrial cavity (normal variant) - Unicornuate: only one half of the uterus
has developed - Didelphys: the two halves of the uterus
remain separate
Uterus – pathology – fibroids: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
- Description – Also called a leiomyoma.
Benign tumour of the myometrium.
Most common type of benign uterine
neoplasm. - They are composed of smooth muscle and
fibroud tissue. They are commonly multiple
Causes
* Seen in 25% of women of reproductive age
and over 70% of women by menopause.
* Are stimulated by oestrogen
* More common with increasing age and with
a family history
* Symptoms
* Often asymptomatic
* Pain, bleeding, mass
Diagnosis
* They can atrophy, haemorrhage and
calcify
* AXR – popcorn type calcification may
suggest
* CT – soft tissue density with calcification
* MRI – only required for complex cases –
but more sensitive than US.
* US – most common assessment choice.
* Will see a hypoechoic lesion with calcification
Complications
* Rare malignant change
* Rare haemorrhage
Treatment
* Myomectomy but high recurrence rate
* Hysterectomy
Differential diagnosis
* Malignant mass
Uterus – pathology – endometrial
polyps: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description – benign
nodular masses that grow
out from the endometrium.
Causes
* Incidence increases with age
* Risk factors include
endometriosis, foreign bodies
Symptoms
* Asymptomatic.
* Common cause of post
menopausal bleeding
Diagnosis
* HSG – can see a filling defect in the uterine
cavity
* US – patient should be postmenstrual
* Will see a homogenous and echogenic lesion
with or without a stalk
* 3D US is useful in defining the polyps
borders
* MRI – may see a mass surrounded by fluid
* Complications
* Most polyps are benign
Treatment
* Polypectomy
* Differential diagnosis
* Fibroids
* Endometrial cancer
Uterus – pathology – endometrial
cancer: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* One of the more common
gynaecological malignancies
* Peak incidence 60+
* Risk factors
* HRT (oestrogen)
* Polycystic ovaries
* Nulliparity
* Diabetes
* Associated with HNPCC
Symptoms
* Commonly early stage bleeding
Diagnosis
* TVUS is the best initial imaging. If a
thickened endometrium is seen, it needs
sampling.
* CT has a role in assessing for mets
* Pelvic MRI is the best for locals staging
Complications
Treatment
* Surgery and chemo/radiotherapy
* Physiology
* There are 2 types
* Type 1 is generally a slow growing tumour with
a better outcome
* Type 2 – tends to spread early via the lymphatics or through the fallopian tubes into
the peritoneum so has a poorer prognosis
Cervix – cervical cancer: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Malignancy arising
from the cervix
* Typically seen in
younger women
Causes
* HPV infection –
sexual history is
linked to this
* Oral contraceptives
* Smoking
* Symptoms
* Bleeding
* Abnormal smear test
Diagnosis
* Only visible on imaging
when large.
* Distant mets are best
assessed with CT or
PET
* US – heterogenous,
hyperechoic mass
* MRI – on T1 will see a
isointense mass
Complications
* mets
Treatment
* Depends on staging
* Differential diagnosis
* Cervical polyps
Cervix – cervical polyps: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Growths in the
cervical canal
* Most patients are
perimenopausal
Causes
* Associated with
endometrial polyps
* Symptoms
* Bleeding
Diagnosis
* US – polypoid
lesion with a clear
outline.
Complications
* Rarely undergoes
malignant change
Treatment
* Surgical removal
Differential diagnosis
* Cervical cancer,
endometrial polyp
Fallopian tubes - hydrosalpinx: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Describes fluid filled
dilatation of the
fallopian tube/s
* The fallopian tube is
occluded at its distal
end so secretions
accumulate.
Causes
* Links to endometriosis
and pelvis
inflammatory disease
Symptoms
* Asymptomatic
* Pelvic pain / infertility
Diagnosis
* US – thin or thick walled
tube, has a tubular S
shape
* MRI – modality of choice.
Can give so much detail
* HSG – will show a dilated
fallopian tube filling with
contrast and no spillage
* Complications
* Tube torsion
Treatment
* Salpingotomy
* Salpingectomy
* US guided aspiration
* IVF for pregnancy
Differential diagnosis
* Cancer, bowel obstruction
Fallopian tubes – endometriosis: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Is the presence of functional
endometrial glands outside the uterus
* Can be superficial (peritoneal), ovarian
and deep
* Most common location is the ovaries
Causes
* Typically presents in young women
* Pathogenesis not fully understood
* Symptoms
* Infertility
* Pelvic pain
* Unusual symptoms
Diagnosis
* Laparoscopy was the gold standard
* New guidelines recommend US and MRI as
a first test
* But negative result still required a
laparoscopy
* MRI - over 90% sensitivity and specificity
* US – over 90%. Good for identifying endo
affecting the bowel or bladder
Complications
Treatment
* Medical treatment for hormone regulation
* Surgery to remove
Differential diagnosis
* Dermoid cyst
Ovaries – ovarian cancer: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Many different types
* Most common are epithelial
tumours – range from benign to
malignant
Causes
* Risk factors include nulliparity,
early menopause, family history
* Oral contraceptives have a
protective factor
Symptoms
* May be none, or bleeding and
pain
Diagnosis
* CA125 levels
* Appearances range from a
cystic structure to a
heterogenous mass.
* Complications
* It can be hard to localise the
symptoms
Treatment
* Depends on tumour type
* Differential diagnosis
Ovaries – ovarian cysts: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Common
* Vary between aetiology
* Small cystic ovarian structures are normal ovarian follicles unless the patient is pre-pubertal. Post-menopausal, pregnant or the diameter is more than 3cm
Causes
* Not known
Symptoms
* Pain
* Symptoms may be referred
Diagnosis
* US normally first line imaging.
* Will see an anechoic mass with a thin wall
Complications
* Rupture
Treatment
* Large cysts may be surgically
resected
* Small are treated conservatively
or the patient may be monitored
Differential diagnosis
Ovaries – teratoma: Description, causes, symptoms, diagnosis, complications, treatment, differential diagnosis.
Description
* Germ cell tumour that arises from
stem cells that fail to migrate from
the yolk sac during embryogenesis
* Most commonly found in the ovary
(known as a dermoid cyst),
testicles and mediastinum
* Very slow growing
* Tend to be seen in young
women
Symptoms
* Asymptomatic
* Pain
Diagnosis
* They can have very different appearances
* May have fat, soft tissue and calcifications like
teeth
* AXR – may see teeth in the pelvis
* US – preferred imaging. Can see a cystic adnexal
mass
* CT has high sensitivity but not often used due to
age of patients
* MRI – normally reserved for tricky cases but is
very sensitive.
Complications
* Tosion, malignant transformation
Treatment
* Conservative
* Surgery
Differential diagnosis
* Some types of ovarian cancer
