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FGT Flashcards

1
Q

What is the primary imaging modality for Female genital tract and pelvis?

A

UTZ

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2
Q

UtZ is used to:

A

Adjunct to PE to confirm the presence of pelvic mass:

  • SIZE
  • CONTOUR
  • CHARCTER
  • DETERMINE THE ORGAN OF ORIGIN
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3
Q

What is the function of UTZ?

A
  • Evaluate for the involvement of other organs.
  • Detect the presence of ascites, hydronephrosis and metastases.
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4
Q

What is Transabdominal UTZ?

A

It uses the urinary bladder as window to the pelvis

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5
Q

What is Transvaginal UTZ?

A

–Improve visualization of all lesions and to overcome the limited bladder filling and obesity

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6
Q

What is to overcome the limited bladder filling and obesity?

A

Transvaginal

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7
Q

What is the size of cervix in adult compared to prepubertal?

A

1/3 adult

2/3 prepubertal

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8
Q

What is the Dimension of Uterus in pospubertal?

A

9x6x4

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9
Q

What is the size of uterus in menopause?

A

6x2x2

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10
Q

______________________- most common uterine position of uterus

A

Anteverted

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11
Q

UTZ must always be correlated with the stage of

A

menstrual cycle

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12
Q

What are the two things that UTZ affects in a normal uterus?

A

brightness and thickness of endometrium

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13
Q

At the end of menstruation the edometrium is________________

A

discrete

thing

2-3mm

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14
Q

In the proliferative change

A

Assume a 3 layer appearance

Anterior and posterior endometrium

Uterine cavity

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15
Q

In the secretory phase

A

Can go upto 14 mm

More uniformly echogenic

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16
Q

ADNEXAE

A

“FOBO”

1. OVARIES

2. FALLOPIAN TUBES

3. BROAD LIGAMENTS

4. OVARIAN AND UTERINE VESSELS

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17
Q

Describe the ovary in UTZ

A

•Oval soft tissue structures with multiple small cystic follicles

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18
Q

What is the max size of the ovary?

A

Size maximum of 5 cm in any one of dimension

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19
Q

What is the dimension of the ovary?

A

4x3x2 (+5cm)

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20
Q

What is the max volume of the ovary?

A

22 ml

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21
Q

What is use to best evualute the ovaries?

A

TVS

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22
Q

Ovaries shows characteristic morphological change during menstruation

A
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23
Q

Following menstruation, ovaries are at their smallest ____________

A

measuring less than 5 mm

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24
Q

– The ovary in this phace is that** follicles enlarge** with one dominant follicle attaining

20 – 25 mm by mid cycle

A

Estrogen phase

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25
Q

What is the apperance of the ovary in the Post Menopausal Ovaries?

A

•Atrophic
•Lack follicles
Difficult to visualize

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26
Q

What is the mean volume of the ovary at age 40-44

A

8 ml

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27
Q

The mean vol of ovary at age 70

A

<1.0 ml

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28
Q

What is the maximal volume in the post menopausal ovary?

A
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29
Q

–Not usually seen unless enlarged

A

Fallopian tubes

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30
Q

When can Broad ligament be seen ?

A

–Seen when outlined by fluid in the pelvis

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31
Q

What are the 3 groups of Disease in FGT?

A
  • benign
  • malignant
  • congenital
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32
Q

What are your Benign diseases?

A
  1. Benign Cystic Teratoma
  2. PID
  3. Tubo-ovarian Abcess
  4. Endometriosis
  5. Simple Ovarian Cyst
  6. Complex Ovarian Cyst
  7. Hemorrhagic Ovarian Cyst
  8. Complex Adnexal Masses
  9. functional Ovarian Cyst
  10. PCOS
  11. Uterine Leiomyomas
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33
Q

What is the MOST COMMON OVARIAN NEOPLASM?

A

Benign Cystic Teratoma

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34
Q

What is Benign Cystic Teratoma?

A
  • Dermoid cyst
  • Germ cell tumors
  • 10 – 30 years old

•Mature ectodermal elements:
–Bone, teeth and hair

35
Q

What is the Imaging Modality of Choice of Benign Cystic Teratoma?

36
Q

What is the 3 common appearance of Benign Cystic Teratoma?

A

•3 common appearances:

–Cystic mass with complex fluid and mural node (dermoid plug)
–“Tip of iceberg appearance”
–Multiple fine echogenic strands

37
Q

Cystic mass with complex fluid and mural node (dermoid plug)

“Tip of iceberg appearance” echogenic mass that fades into acoustic shadowing because of sound absorption

Multiple fine echogenic strands

A

Benign Cystic Teratoma

38
Q

What are the causes of PID?

A

STD

Secondary to instrumentation

39
Q

What are the symptoms of PID

A

•Symptoms:
–Lower abdominal pain
–With or without vaginal discharge

40
Q

This is a disease that does not need necessary imaging unless there is clinical uncertainty or suspected abscess?

A

Pelvic Inflammatory Disease

41
Q

–Initial imaging modality of choice of PID

A

•Ultrasound

42
Q

What is Tubo-ovarian Abscess in UTz?

A

Transvaginal ultrasound shows a thick walled septated left adnexal mass (arrow), in keeping with a tubo-ovarian abscess.

•
•Multi-locular complex retro-uretine/adnexal mass(es) with debris, septations, and irregular thick walls
•

43
Q

In tubo-ovarian absecess,
•Adjunct to ultrasound especially in determining the extent of disease.

44
Q

What is the appearance of Tubo-ovarian Abscess in CT Scan

A

•Thick enhancing wall fluid density pelvic masses which may contain fluid- fluid levels or gas

45
Q

•Benign but chronic inflammatory disease

A

Endometriosis

46
Q

What is the % of Endometriosis in childbearing age?

A

•10% - childbearing age

47
Q

What is the percentage of women with infertility?

48
Q

Peirtoneum – ovary cul-de sac, bowel

Ectopic endometrium outside the uterus

49
Q

Deep endometriosis: In the latter case, the____________ can

all be involved.

A
  • genital tract,the
  • urological tract,
  • the abdominal wall and
  • the bowel
50
Q

What are the symptoms of Endometriosis?

A
  • Premenstrual abdominal pain
  • Dysmenorrhea
  • Chronic pelvic pain
  • Dyspareunia
51
Q

NO IMAGING TECHNIQUE IS PARTICULARLY USEFUL IN ENDOMETRIOSIS. T or F

52
Q

What is the Gold standard for Endometriosis?

A

•Laparoscopy

53
Q

What is the signal of Endometriosis in MRI inT1W1

A

HIgh

1st honor has HIgh grades

54
Q

Endometriosis in MRI has ___________ signal intensity in T2w1

A

•Low signal intensity in T2WI

55
Q

What is the reason of Low intensity signal in T2

A

old blood due to recurrent hemorrhage

56
Q

In edometriosis MRI

  1. Superficial lesion
  2. On MRI these lesions are most often not visible because they are tiny and flat, and therefore **undetectable. **

Only when they exceed ____________or when they___________, showing high signal intensity on T1 and low signal intensity on T2-weigthed images, they may be detected (figure).

A
  1. 5mm
  2. appear as hemorrhagic cysts
57
Q

The sagittal T2-image shows full-thickness bladder endometriosis with isointense signal compared to muscle and foci of high signal intensity, indicating_______________

A

dilated endometrial glands.

58
Q

What is the appearance of Endometrios in UTZ?

A
  • Mass
  • Maybe cystic
  • May contain particulate fluid

There is a mixed-to-hypoechoic, heterogeneous, lobulated mass in the subcutaneous tissue of the right lower quadrant. This mass is mobile and is clearly separate from the anterior abdominal wall muscles.

59
Q

What is the appearance of ovarian cyst in UTZ?

A

No internal echoes

Smooth walls

Good transmission of sound waves through the cyst to underlying structures.

60
Q

SIMPLE OVARIAN CYST is •Very common
•Imaging modality of choice:

A

Ultrasound

61
Q

What is the appearance of Simple Ovarian cyst in UTZ?

A

–No internal echoes
–Smooth walls
–Good transmission of sound waves through the cyst to underlying structures.

62
Q

•Hemorrhagic and solid components

A

Complex Ovarian Cyst

63
Q

What is the appearance of Complex Ovarian Cyst in UTZ?

A

•UTZ:
–Ground-glass
–Fenestrated
–Lacelike pattern
–NO solid components!

64
Q
A

Hemorrhagic Cyst–Layering Blood. Settling blood products produce a fluid-fluid layer (small arrows) within this hemorrhagic ovarian cyst shown on TV US. Large arrow indicates the direction of “up” during transvaginal scanning.

65
Q

Complex Adnexal Masses

A
  • C – cystadenoma or cystadenocarcinoma
  • H – hemorrhagic cyst
  • E – endometrioma
  • E – ectopic pregnancy
  • T – teratoma (dermoid cyst)
  • A - Abscess
  • H – hematoma
66
Q

•Most common ovarian mass
•Normal follicles:
–2.5 cm

A

Functional Ovarian Cyst

67
Q

When is Functional Ovarian Cyst is pathological?

68
Q

What is the reason when Functional cyst becomes pathological?

A

due to excessive accumulation of fluid or internal hemorrhage

69
Q

Functional Ovarian Cyst appearance in UTZ

A
  • Round
  • Smooth
  • Unilocular
  • Resolves on follow-up after 1 or 2 menstrual cycle.
70
Q
  • Clinical and biochemical diagnosis
  • Hirsutism, amenorrhea, infertility and obesity
A

Polycystic Ovarian Syndrome (PCOS)

71
Q

How many percent in PCOS does

–Both ovaries are enlarged with multiple follicles (> 10 – 12 follicles per ovary)

72
Q

•30% in PCOS have

A

–Completely normal ovaries

73
Q

What population may have ovaries with multiple follicles but lack clinical features of PCOS

A

Patients with anovulatory menses especially young female atheletes

74
Q

•Most common uterine tumor affecting 50% of women in reproductive age.
•Benign, smooth muscles with variable amount of fibrous tissues.
•Asymptomatic
•Can lead to excessive bleeding, pelvic pain, mass symptoms and infertility.

Most women are asymptomatic

Subserosa and submucosa maybe pedunculated

A

Uterine Leiomyomas

75
Q

•Locations: Uterine LEIOMYOMAS
–Intramural
•Within the myometrial wall

A

–Intramural

76
Q

•Beneath the endometrium

A

–Submucosal

77
Q

•Beneath the serosa

A

–Subserosal

78
Q

What part of Uterine Leiomyomas may be pedunculated?

A

Subserosa and submucosa maybe pedunculated

79
Q

What is the signal of Uterine leiomyomas in MRI

A

•Both low signals in T1 and T2

MRI provides the best chaRActerization, number and location

80
Q

What is the appearance of Uterine leiomyomas in CT scan?

A

•
•Heterogeneous or homogeneous masses
•Coarse calcification in the mass is common and Characteristic!

81
Q

What is the characteristic of Uterine leiomyomas in CT scan?

A

•Coarse calcification in the mass is common and Characteristic!

82
Q

What is the appearance of Uterine leiomyomas in XRAy?

A
  • Calcification
  • “Popcorn Appearance”
83
Q

Uterine leiomyomas: X-ray

A

•
•Enlarged uterus
•Hypoechoic
•Acoustic shadowing

Diagnostic Imaging (6 decks)

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