Gynecology ( IMAGES ) Flashcards
Broad ligament outlined by ascites.
They are clearly noted in this transverse image ( uterus )
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).
Endovaginal transverse image of the uterus demonstrating the myometrium (A), the endometrium (B), and the serosa (C).
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).
Postmenopausal uterus
demonstrating an atrophic uterus
Anteverted
Retroverted
Anteflexed
Retroflexed
DIDELPHYS
Double uterus and vagina
Uterus duplex bicornis
Uterus bicornuate
Uterus Unicornuate
Complex septate uterus
Subseptate uterus
Septate uterus
Didelphys uterus
Revealing two separate endocervical canals and separate right and left uterine horns
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.
Hematometra.
The (uterus is distended ) with echogenic fluid (f) representing blood.
Hematocolpos.
Sagittal image of a 12-year-old girl with cyclic pain demonstrating a (blood-filled distended vagina )
SONOGRAPHIC FINDINGS OF ADENOMYOSIS
- Diffusely enlarged uterus
- Hypochoic or echogenic areas adjacent to endometrium
- Heterogeneous myometrium
- Myometrial cysts
- Ill-defined interface between myometrium and endometrium
- Thickening of the fundus or posterior myometrium
Fibroid locations
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)
Nabothian cyst.
Sagittal endovaginal view of the uterus revealing a cyst within the cervix
Nabothian cyst. Sagittal endovaginal view of the uterus revealing a cyst with the cervix
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
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
Simple ovarian cyst.
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
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
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.
Paraovarian cyst.
A. A simple appearing cyst is noted adjacent to the ovary and posterior to the urinary bladder in sag and trv images
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
Tip of iceberg sign seen with dermoid / cystic teratoma.
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
Can be mistaken for a fibroid
Ovarian fibroma.
Sagittal image of the right ovary demonstrating a solid mass with a homogeneous echotexture
Endometrioma filled with homogeneous echoes
Images of cystic adnexal mass filled with homogeneous echoes consistent with the sonographic findings
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
Ovarian mucinous cystadenoma.
A transabdominal image demonstrating characteristics of a mucinous cystadenoma, which includes the presence of echogenic material within the mass.
Ovarian (papillary) cystadenocarcinoma.
Image of an ovarian mass with an internal solid nodule projecting from its wall.
(This was confirmed to be ovarian cvstadenocarcinoma)
Ovarian mucinous cystadenocarcinoma.
Transvaginal images of a large ovarian mass surrounded by ascites
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).
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
Hydrosalpinx.
Coronal image of a dilated right fallopian tube filled with anechoic fluid.
Note the folds (arrowheads of the tortuous tube)
Pyosalpinx.
Echogenic debris or pus is noted within this dilated and inflamed fallopian tube
Sonographic appearance of the endometrium shortly after menses.
Note the thin endometrium
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.
Sonographic appearance of the endometrium during the secretory phase.
endometrium appears thick and echogenic.
Normal postmenopausal endometrium
This endometrium appears thin and echogenic
Endometrial atrophy.
Longitudinal transvaginal sonogram revealing a thin endometrium measuring only 2 mm in a postmenopausal woman with vaginal bleeding
thickened endometrium is demonstrated in this patient with endometrial hyperplasia.
Endometrial carcinoma
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
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.
SIS and multiple endometrial polyps.
Pelvic inflammatory disease.
Transverse transabdominal image of the female pelvis revealing bilateral complex adnexal masses in the setting of an extensive pelvic infection.
Pyosalpinx.
This dilated tube seen posterior to the urinary bladder, contains pus and has a thickened wall.
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
Tubo-ovarian abscess.
Transvaginal image of a complex adnexal mass with poorly defined borders and complex fluid.
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
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
Endometrial adhesion.
A. Normal-appearing endometrium
B. With saline infusion (*) during a saline infusion sonohysterogram, an endometrial adhesion is noted
Ovarian hyperstimulation syndrome.
Dramatically enlarged ovary secondary to ovulation induction medication.
IUD in trv and sag
Intrauterine device and coexisting intrauterine pregnancy.
Essure devices
Second trimester triple screen test consists of?
MSAFP
HCG
Estriol
MSAFP is produced by?
Yolk sac and fetal liver
Estriol and hCG produced by ?
Placenta
Two supplementary proteins addition to the triple screen test ?
PAPP- A
Inhibin A
(Both are produced by the placenta)
Simple blood test that can detect trisomy 13/18/21 and sex chromosome abnormalities soon as 9 weeks ?
MaterniT 21Plus blood test
Advanced maternal age ?
Considered over > 35 years old
Greater risk of having an abnormal pregnancy or pregnancy failure
Three main procedures used to obtain fetal karyotyping ?
CVS / Chorionic Villus Sampling
Amniocentesis
Cordocentesis
Chorionic Villus Sampling ?
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)
Amniocentesis?
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)
Therapeutic Amniocentesis ?
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
Cordocentesis ?
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
Most common chromosomal abnormality ?
Down Syndrome/ Trisomy 21
Down Syndrome ?
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
Sonographic findings of Down’s syndrome / trisomy 21?
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
Edwards Syndrome ?
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
Sonographic findings of Edwards Syndrome?
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)
Patau syndrome ?
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
Sonographic findings of patau syndrome ?
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
Triploidy ?
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
Sonographic findings of triploidy ?
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
Turner syndrome ?
Found in females
45,X or monosomy X
Associated with nonimmune hydrops and cystic hygroma
Nonimmune hydrops?
Buildup of fluid accumulation within atleast 2 fetal body cavities
(Pleural effusion, pericardial effusion, ascites, and subcutaneous edema)
Klinefelter syndrome ?
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
