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Diagnostic Medical Sonography > Gynecology ( IMAGES ) > Flashcards

Gynecology ( IMAGES ) Flashcards

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USMLE® Step 1 flashcards
1
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Broad ligament outlined by ascites.
They are clearly noted in this transverse image ( uterus )

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7
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Sagittal transabdominal image of the uterus demonstrating posterior to the distended urinary bladder (F), the uterine fundus (A), uterine corpus (B), uterine isthmus (C), cervix (D), and vagina (E).

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8
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Endovaginal transverse image of the uterus demonstrating the myometrium (A), the endometrium (B), and the serosa (C).

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9
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Sagittal endovaginal image of the endometrium demonstrating the outermost basal layer (A), the innermost echogenic stripe of the uterine cavity (B), and the functional layer (C).

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10
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Postmenopausal uterus
demonstrating an atrophic uterus

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11
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12
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Anteverted

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13
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Retroverted

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14
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Anteflexed

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15
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Retroflexed

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16
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DIDELPHYS
Double uterus and vagina

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17
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Uterus duplex bicornis

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18
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Uterus bicornuate

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19
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Uterus Unicornuate

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20
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Complex septate uterus

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21
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Subseptate uterus

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22
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Septate uterus

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23
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Didelphys uterus
Revealing two separate endocervical canals and separate right and left uterine horns

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24
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Hydrocolpos.
Simple appearing fluid is noted posterior to the urinary bladder (B) and inferior to the cervix (C) within the vagina (V) in this sagittal image of the neonatal pelvis.

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25
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Hematometra.
The (uterus is distended ) with echogenic fluid (f) representing blood.

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26
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Hematocolpos.
Sagittal image of a 12-year-old girl with cyclic pain demonstrating a (blood-filled distended vagina )

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27
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SONOGRAPHIC FINDINGS OF ADENOMYOSIS

  1. Diffusely enlarged uterus
  2. Hypochoic or echogenic areas adjacent to endometrium
  3. Heterogeneous myometrium
  4. Myometrial cysts
  5. Ill-defined interface between myometrium and endometrium
  6. Thickening of the fundus or posterior myometrium
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28
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Fibroid locations

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29
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Leiomyosarcoma.
Sagittal and transverse (IRV) transabdominal views of the uterus in a postmenopausal woman demonstrating a hypochoic mass in the uterus.
Initially diagnosed as a fibroid.
Images taken views 5 months later showing the mass has grown substantially. Pathology following a hysterectomy revealed the diagnosis of leiomyosarcoma ( rapid growth rate)

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30
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Nabothian cyst.
Sagittal endovaginal view of the uterus revealing a cyst within the cervix

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31
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Nabothian cyst. Sagittal endovaginal view of the uterus revealing a cyst with the cervix

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32
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sonographic appearance of the ovary.
In this longitudinal endovaginal image of the pelvis, the ovary is noted adjacent to the iliac artery and iliac vein
A longitudinal transabdominal image of the pelvis between the urinary bladder and prominent ureter

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33
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Normal ovarian
the menstrual cycle revealing a high-impedance waveform.

Transverse image of the ovary during day 10 of the menstrual cycle revealing a low-impedance waveform pattern with more diastolic flow

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34
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Simple ovarian cyst.

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35
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Hemorrhagic ovarian cyst.
A. ovary demonstrating a hemorrhagic ovarian cyst with a weblike appearance and focal thickening of the wall
B. Color Doppler image depicts flow within the peripheral ovarian tissue

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36
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Corpus luteum.
The range of sonographic appearances of the corpus luteum includes that of a thin-walled unilocular cyst
(A), a thick-walled cyst
(B), a complex cyst with septations
(C), and structure that contains diffuse internal echoes

(D). On images (A) and (B), the corpus luteum is seen adjacent to a gestational sac within the uterus

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37
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Theca lutein cysts.
Transabdominal image of an enlarged ovary is seen
This patient was undergoing infertility therapy and had a markedly elevated human chorionic gonadotropin blood level.

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38
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Paraovarian cyst.
A. A simple appearing cyst is noted adjacent to the ovary and posterior to the urinary bladder in sag and trv images

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39
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Cystic teratoma.
A. A coronal image of the female pelvis demonstrating a complex ovarian mass with several typical sonographic characteristics of a dermoid, including the dermoid plug and the posterior shadowing from the plug.
B. In the sagittal plane, this dermoid reveals a solid shadowing structure within its borders

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40
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Tip of iceberg sign seen with dermoid / cystic teratoma.

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41
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Granulosa cell tumor.
Longitudinal image of a 3-year-old girl suffering from premature breast development demonstrating a granulosa cell tumor located posterior to the urinary bladder

42
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Can be mistaken for a fibroid
Ovarian fibroma.
Sagittal image of the right ovary demonstrating a solid mass with a homogeneous echotexture

43
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Endometrioma filled with homogeneous echoes
Images of cystic adnexal mass filled with homogeneous echoes consistent with the sonographic findings

44
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A

Ovarian serous cystadenoma
(A and B) Transvaginal color Doppler images of cystic ovarian lesion with anechoic fluid and a few thin septations
C. Spectral Doppler showing blood flow within the septations

45
Q
A

Ovarian mucinous cystadenoma.
A transabdominal image demonstrating characteristics of a mucinous cystadenoma, which includes the presence of echogenic material within the mass.

46
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A

Ovarian (papillary) cystadenocarcinoma.
Image of an ovarian mass with an internal solid nodule projecting from its wall.
(This was confirmed to be ovarian cvstadenocarcinoma)

47
Q
A

Ovarian mucinous cystadenocarcinoma.
Transvaginal images of a large ovarian mass surrounded by ascites

48
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A

Low-resistance flow in ovarian cancer.
Spectral Doppler of a vessel within this ovarian papillary cystadenocarcinoma demonstrating low-resistance flow with a low pulsatility index (PI).

49
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A

Ovarian torsion.
A. Sagittal image of right ovary showing enlargement (>5 cm), globular shape, and edema, all as a result of torsion.
B. Sagittal view with color Doppler showing no flow in the torsed ovary

50
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51
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Hydrosalpinx.
Coronal image of a dilated right fallopian tube filled with anechoic fluid.
Note the folds (arrowheads of the tortuous tube)

52
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Pyosalpinx.
Echogenic debris or pus is noted within this dilated and inflamed fallopian tube

53
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54
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55
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56
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Sonographic appearance of the endometrium shortly after menses.
Note the thin endometrium

57
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Sonographic appearance of the endometrium during the late proliferative (periovulatory) phase, also referred to as the “three-line” sign.
The outer echogenic basal layer surrounds the more hypochoic functional layer, whereas the functional layer is separated by the echogenic endometrial stripe.

58
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A

Sonographic appearance of the endometrium during the secretory phase.
endometrium appears thick and echogenic.

59
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Normal postmenopausal endometrium
This endometrium appears thin and echogenic

60
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Endometrial atrophy.
Longitudinal transvaginal sonogram revealing a thin endometrium measuring only 2 mm in a postmenopausal woman with vaginal bleeding

61
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A

thickened endometrium is demonstrated in this patient with endometrial hyperplasia.

62
Q
A

Endometrial carcinoma

63
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A

Endometrial polyp and saline infusion sonohysterography.
A. A polyp is suspected in a patient with focal thickening of the endometrium
B. Saline infusion sonohysterography better depicts the evidence of an endometrial polyp

64
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A

Tamoxifen effects on the endometrium.
A 62-year-old woman with postmenopausal bleeding undergoing tamoxifen therapy.
The sagittal view of the uterus revealing a thickened endometrial lining with cystic changes.
A polyp was confirmed.

65
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SIS and multiple endometrial polyps.

66
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A

Pelvic inflammatory disease.
Transverse transabdominal image of the female pelvis revealing bilateral complex adnexal masses in the setting of an extensive pelvic infection.

67
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A

Pyosalpinx.
This dilated tube seen posterior to the urinary bladder, contains pus and has a thickened wall.

68
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A

Tubo-ovarian complex.
Longitudinal transabdominal image of the adnexa revealing a complex adnexal mass composed of a dilated fallopian tube and enlarged ovary seen posterior to the bladder

69
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Tubo-ovarian abscess.
Transvaginal image of a complex adnexal mass with poorly defined borders and complex fluid.

70
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71
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72
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Endometrioma.
A. Fluid-fluid level in an endometrioma. Coronal scan of the left ovary revealing a cystic adnexal mass containing a fluid-fluid level
B. Transvaginal image of a homogeneous mass containing low-level echoes

73
Q
A

Polycystic ovary. ( PCOS )
Longitudinal sonogram demonstrating an enlarged round ovary with multiple small follicles less than or equal to 8 mm in diameter located around the periphery of the ovary
string of pearls sign.
The stroma (S) of the ovary also appears to have increased echogenicity between the cysts

74
Q
A

Endometrial adhesion.
A. Normal-appearing endometrium
B. With saline infusion (*) during a saline infusion sonohysterogram, an endometrial adhesion is noted

75
Q
A

Ovarian hyperstimulation syndrome.
Dramatically enlarged ovary secondary to ovulation induction medication.

76
Q
A

IUD in trv and sag

77
Q
A

Intrauterine device and coexisting intrauterine pregnancy.

78
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A

Essure devices

79
Q

Second trimester triple screen test consists of?

A

MSAFP
HCG
Estriol

80
Q

MSAFP is produced by?

A

Yolk sac and fetal liver

81
Q

Estriol and hCG produced by ?

A

Placenta

82
Q

Two supplementary proteins addition to the triple screen test ?

A

PAPP- A
Inhibin A

(Both are produced by the placenta)

83
Q

Simple blood test that can detect trisomy 13/18/21 and sex chromosome abnormalities soon as 9 weeks ?

A

MaterniT 21Plus blood test

84
Q

Advanced maternal age ?

A

Considered over > 35 years old
Greater risk of having an abnormal pregnancy or pregnancy failure

85
Q

Three main procedures used to obtain fetal karyotyping ?

A

CVS / Chorionic Villus Sampling
Amniocentesis
Cordocentesis

86
Q

Chorionic Villus Sampling ?

A

Obtained during pregnancy for karyotyping
Done between 10 and 13 weeks — under sonographic guidance ;
A needle or a plastic catheter is placed within the placenta to obtain a sample of trophoblastic cells

(When the procedure is performed before 10 weeks there is speculations of it being linked to fetal limb abnormalities)

87
Q

Amniocentesis?

A

Used for genetic purposes between 15 and 20 weeks

(Procedure done before 15 weeks has been linked to increase in fetal complications)

Procedure is done Transabdominally with sonographic guidance while a needle is inserted into the abdomen into the amniotic sac to remove amniotic fluid sample for testing

Most common side effect is uterine contractions and cramping.

Can take as long as 3 weeks for a complete analysis of the fluid

Also can be done to assess lung maturity by assessing the L : S. Ratio (lecithin to sphingomyelin)

88
Q

Therapeutic Amniocentesis ?

A

Can be peformed to aspirate and relieve the patients from polyhydramnios or can be used to distend the amniotic cavity with more fluid when oligohydramnios is present

89
Q

Cordocentesis ?

A

Percutaneous umbilical cord sampling (PUBS)

Fetal blood sampling from a needle being sonographically guided transabdominal through the maternal abdomen, into the umbilical cord near the insertion site of the cord to the placenta (umbilical vein)

Can lead to fetal bradycardia and hemorrhage at the sampling site

PUBS allows for rapid detection rate of less than 72 hours for results and detection of chromosomal anomalies

Carries a higher fetal loss rate than amniocentesis

90
Q

Most common chromosomal abnormality ?

A

Down Syndrome/ Trisomy 21

91
Q

Down Syndrome ?

A

Trisomy 21/ extra chromosome 21

Duodenal atresia, NT increased thickness in the first trimester, increased NF thickness in the second trimester, pyelectasis, and absent nasal bones

With elevated Inhibin A, and hCG but all other lab test values will be decreased

92
Q

Sonographic findings of Down’s syndrome / trisomy 21?

A

Absent nasal bone
Brachycephaly
Clinodactyly
Duodenal atresia
EIF/ echogenic intracardiac focus
Echogenic bowel
Macroglossia
Mild ventriculomegaly
Nonimmune hydrops
Nuchal thickening (>6 mm from 15 to 21 weeks )
Thickened nuchal translucency
Pericardial effusion
Pyelectasis / hydronephrosis
Sandal gap
Shortened limbs (humerus/femur)
VSD / ventricular Septal Defect
Widened pelvic angles

93
Q

Edwards Syndrome ?

A

Trisomy 18
Second most common chromosomal abnormality

Majority of these fetus’ die either before birth or shortly after

Strawberry shaped skull, choroid plexus cysts, micrognathia, rocker bottom feet, omphalocele, clenched fists, and single umbilical artery in the cord (usually 1V/ 2A)

All lab test values are decreased

94
Q

Sonographic findings of Edwards Syndrome?

A

Strawberry shaped skull
ACC/ agenesis of corpus callosum
Choroid plexus cysts
Hypoplastic cerebellum
Enlarged cisterna magna
Hydrocephalus
Micrognathia
Small low set ears
Esophageal atresia
Spina bifida / A.C.M.
Clenched hands, overlappping index fingers, fixed wrists
Cardiac defects (including VSD and tetralogy of fallot)
Omphalocele
Nonimmune hydrops
Diaphragmatic hernia
Renal anomalies
Single umbilical artery
Feet abnormalities (rocker bottom feet, clubfeet)

95
Q

Patau syndrome ?

A

Trisomy 13 / additional 13 chromosome

Almost a uniformly fatal condition with the fetus typically dies in the neonatal period

Common findings includes ; holoprosencephaly and abnormal facies

Associated with;
Central nervous system aberrations, cyclopia, facial clefting, heart defects, and polydactyly

Maternal serum screening is not always beneficial when diagnosing this condition

96
Q

Sonographic findings of patau syndrome ?

A

Macrocephaly
Polydactyly
Holoprosencephaly
Ventriculomegaly
Hydrocephalus
ACC/ agenesis of corpus callosum
Small and low set ears
Facial anomalies (cyclopia, cleft lip/ palate, Microphthalmia and hypotelorism)
Cardiac defects (hypoplastic left heart and EIF/ echogenic intracardiac focus)
Omphalocele
Nonimmune hydrops
Renal anomalies (hydronephrosis , echogenic enlarged kidneys)
Single umbilical artery
Clubfeet

97
Q

Triploidy ?

A

Chromosomal abnormality which fetus has 3 sets of chromosomes (69 total)

Most fetus die within the first or early second trimester

Can be associated with a partial mole pregnancy — hence markedly high hCG levels and bilateral theca lutein cysts present

Associated with ;
Small low set ears, cardiac defects, syndactlyly, and IUGR

98
Q

Sonographic findings of triploidy ?

A

Holoprosencephaly
DWM— dandy Walker malformation
ACC / agenesis of corpus callosum
Hydrocephalus
Facial abnormalities (Microphthalmia and micrognathia)
Small low set ears
Cardiac defects
Renal anomalies
IUGR (small abdomen)
Omphalocele
Syndactlyly (third and fourth fingers)
Single umbilical artery
Clubfeet

99
Q

Turner syndrome ?

A

Found in females
45,X or monosomy X
Associated with nonimmune hydrops and cystic hygroma

100
Q

Nonimmune hydrops?

A

Buildup of fluid accumulation within atleast 2 fetal body cavities
(Pleural effusion, pericardial effusion, ascites, and subcutaneous edema)

101
Q

Klinefelter syndrome ?

A

47, XXY
Male chromosomal anomaly that can result in hypogonadism, small testis, tall stature, long legs / arms, and gynecomastia

Tend to suffer from subnormal intelligence

Diagnostic Medical Sonography (15 decks)

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