Frmale Pelvis Part 2 Flashcards
Sonographic appearance in reproductive years
Vary depending on stage of menstral cycle
For size measurement we take
Take AP measurement at the thickest part
LMP is
Day 1 of the first day of mense
Average menstrual cycle = ___ days
28 days
4 stages of menstral cycle
Early proliferative
Later proliferative
Secretory
Menses
Early proliferative
Day 5-13
5-7 mm
Late proliferative
Day 14-16
>11mm
Secretory phase
Days 16-28
16mm
Menses
Day 1 to 5
Patient history for female pelvis exam
RLQ, LLQ, chronic, acute, pregnancy
Transabdomindal ultra sound
Global view
Limited patients ability to hold and fill bladder, obese patients, retroverted uterus (beyond focal zone of transducer)
Limited resolution depth
Reasons for full bladder
Displaces uterus
Displaces gas
Use as an acoustic window
Technical difficulties on transabdominal US
Obeses
Surgical scar
Gas
Dressing
Advantages of transvag
Better resolution higher frequency transducer
Obese patients
Patients who cannot fill bladder
Retroverted uterus
Better distinction adnexal masses and bowel
Better characterization of internal pelvic mass
better detail of pelvic lesion
better detail of endometrium
Disadvantage tot TVP
Small feild of view
4 portions of fallopian tubes
Intramural
Isthmus
Ampulla
Infindibulum
Length of tubes
7-12 cm
Intramural
1 cm long, narrowest portion
Contained within muscular wall uterus
Isthmus
Medial third of tube
Slighty wider and cordlike
Ampulla
Tortuous, approx half the lenth
Infindibulum
Most distal portion
Funnel shaped end
Opens into the peritoneal cavity
Overies covered by single layer called
Germinal epitherlium which become continuous with peritoneum at the hilim of ovary
Ovary sections
Germinal epithelium -> single layer
Tunica albuginea -> fibrous capsule
Cortex-> where the follicles develop and mature
Medulla-> smaller in volume than cortex , composed of fibrous tissue and blood vessels
Mesovarian ligament
Attaches anterior surface of ovary to posterior surface of broad ligament
Ovarian ligament
Attaches lower pole of ovary to uterus
Suspensory ligament
Attaches upper pole to lateral wall of pelvis lateral extension of broad ligament
Carries ovarian vessels and nerves
Ovarian arteries
From aorta just inferior to renal arteries
Run within suspensory ligament
Gives off branches to ovaries
Anastomose with branches of uterine artery
Ovarian veins
Right ovarian vein drains into IVC
Left ovarian vein drains into left Renal Vein (Remember Lt Gondal vein aka. Lt ovarian in
Ovaries sonographic appearance
Uterine position influences ovarian position Example: uterus is left sided the ipsilateral ovary can lie superior to fundus of uterus Usually lateral or posterolaterally to anteflexed midline uterus Variable positions (laxity of ligaments)
Menstrating adult female variable size of ovary
6.8 cc
Echotexture of ovary
Homogenous
Echogenicity of ovary
Echogenicity Central, more echogenic medulla Small, well defined anechoic or cystic follicles may be seen in periphery in the cortex Echogenic ovarian foci Commonly seen Non-shadowing
Echogenic foci in vary
Usually in periphery but can be diffuse
Specular reflectors of tiny, unresolved cysts
Focal calcification in ovary
Occasionally seen
Changes in ovary during early proliferative phase
Follicles stimulated by FSH (follicle stimulating hormone) and LH (luteinizing hormone)
Increase in size until day 8 or 9
One follicle becomes Dominant
Dominant reaches size 2.0 to 2.5 cm at ovulation
Follicular cyst develops if fluid in one of the nondominant follicles is not resorbed
Corpus luteum
Develops after ovulation
“empty house”
Seen as a small, hypoechoic or isoechoic structure in periphery of ovary
Involutes before menstruation
Sonographic appearance of corpus luteum
Small size and lack of follicles
Less likely to be seen after hysterectomy due to loss of normal anatomic landmarks
Postmenopausal ovary sonographic appearance
Small
Lack of follicles or completely absent
Hard to find on US
ADNEXA
appendages or accessory structures of an organ
Example in the female pelvis the uterus, the adnexa refers to the adjacent structures:
the uterine tubes and ligaments and ovaries
Take an image of the right and left adnexa, adjacent to uterus
