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Year 2 Medicine > Imaging of the Pelvis Angiography/Ultrasound/MRI COPY > Flashcards

Imaging of the Pelvis Angiography/Ultrasound/MRI COPY Flashcards

1
Q

Which imaging modalities are used in imaging the pelvis? (3)

A
  • Ultrasound and MRI
  • CT use also - esp in emergencies
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2
Q

Advantages of MRI

  • No … radiation
  • better … tissue contrast
    • BUT: Longer … times and more …
A
  • No ionising radiation
  • better soft tissue contrast
    • BUT: Longer examination times and more expensive
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3
Q

Are CT scans used for pelvic imaging?

A
  • Yes - but limited use
  • In abominal emergencies and trauma cases are number 1 cross-sectional imaging investigation
  • soft-tissue contrast is poor
  • artefact from pelvic girdle
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4
Q

The Male Pelvis

  • P…
  • R…
  • I…-rectal fossae
  • Obturator … - … rotation and abduction of …
    • image shown is lower down - image on next slide is 2cm further up
  • B…
  • … vesicles
A
  • Prostate
  • Rectum
  • Ischio-rectal fossae
  • Obturator internus - lateral rotation and abduction of hip
  • image on this slide is 2cm further up, showing:
  • Bladder (large black circular shape in upper middle)
  • Seminal vesicles (sticking out each side of midline - sitting above level of prostate)
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5
Q

Ischio-rectal fossae - what is it?

  • …-filled wedge-shaped space located lateral to the … canal and inferior to the pelvic ….
A

fat-filled wedge-shaped space located lateral to the anal canal and inferior to the pelvic diaphragm.

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6
Q

Obturator internus

  • The obturator internus is the … muscle of hip joint which is part of lateral wall of pelvis. It is found in the superior inner side of the obturator ..
  • Lateral … and … of hip joints
A
  • The obturator internus is the deep muscle of hip joint which is part of lateral wall of pelvis. It is found in the superior inner side of the obturator membrane.
  • Lateral rotator and abductor of hip joints
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7
Q

The Female Pelvis

  • … - 3 zones on MRI
    • Endometrium - colour?
    • Myometrium - colour?
    • Junctional Zone - colour?
  • Ovary - fluid … (on T2 image)
  • B.. on lower image (T2 image)
  • C.. on lower image (T2 image)
A
  • Uterus - 3 zones on MRI
    • Endometrium - bright white
    • Myometrium - grey
    • Junctional Zone - darker grey
  • Ovary - fluid bright (on T2 image)
  • Bladder - lower pic (white area in middle)
  • Cervix - lower pic (behind bladder - directly)
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8
Q

Sagittal MRI

  • Female or Male?
  • Label Structures (white arrow, *, and in between) (also B, R, C?)
A
  • Female
  • B = Bladder - empty
  • * represents endometrium (linear structure running to cervix), white arrow = dark area of junctional zone, myometrium = intermediate grey area
  • C =Cervix
  • R = Rectum
    • As bladder fills - uterine body tilt less acute anterior angulation
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9
Q

The fallopian tube / Ovary

  • Consists of 4 main parts:
  • … (interstitial) part, which is located within the myometrium of the uterus, is 1 cm long and 0.7 mm wide.
  • The …, which is a lateral continuation of the intramural part. It is a rounded, muscular part of the fallopian tube. It is 3 cm long and between 1 and 5 mm wide.
  • The …, which is longest part of the tube. It has a diameter of 1 cm at its widest point and is 5 cm long.
  • The …, which is the distal end of the tube.
A
  • Intramural (interstitial) part, which is located within the myometrium of the uterus, is 1 cm long and 0.7 mm wide.
  • The isthmus, which is a lateral continuation of the intramural part. It is a rounded, muscular part of the fallopian tube. It is 3 cm long and between 1 and 5 mm wide.
  • The ampulla, which is longest part of the tube. It has a diameter of 1 cm at its widest point and is 5 cm long.
  • The infundibulum, which is the distal end of the tube.
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10
Q

The Perineum (Saggital MRI)

  • The perineum is an anatomical region in the pelvis. It is located between the …, and represents the most … part of the pelvic outlet.
  • The perineum is separated from the pelvic cavity superiorly by the pelvic ….
  • On the scan (upper - female scan) you can see the … anteriorly, … most anterior structure, … middle, … most posteriorly
  • Peritoneal reflections in the pelvis:
    • Female - vesico-… pouch
      • Recto-uterine pouch (pouch of …)
    • Male - vesico-… pouch
A
  • The perineum is an anatomical region in the pelvis. It is located between the thighs, and represents the most inferior part of the pelvic outlet.
  • The perineum is separated from the pelvic cavity superiorly by the pelvic floor.
  • On the scan you can see the bladder anteriorly, urethra most anterior structure, vagina middle, rectum most posteriorly
  • Peritoneal reflections in the pelvis:
    • Female - vesico-uterine pouch
      • Recto-uterine pouch (pouch of douglas)
    • Male - vesico-rectal pouch
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11
Q

Pelvic peritoneal reflections/space

  • In males there is only one potential space for fluid collection posterior to the bladder, the … pouch.
  • In females there are two potential spaces posterior to the bladder, the … pouch, and posterior to…the uterus the deeper … pouch (pouch of Douglas).
A
  • In males there is only one potential space for fluid collection posterior to the bladder, the rectovesical pouch.
  • In females there are two potential spaces posterior to the bladder, the uterovesical pouch, and posterior to the uterus the deeper rectouterine pouch (pouch of Douglas).
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12
Q

Pelvic Ultrasound

  • Advantages: (3)
  • Disadvantages: (2)
A
  • Advantages:
    • Fast and cheap
    • no ionising radiation
    • non-invasive
  • Disadvantages:
    • Operator dependent
    • Bone and bowel gas may obscure the image
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13
Q

Transabominal vs Transvaginal U/S

  • Transvaginal used for … assessment (much more detailed)
  • Transabdominal good for showing some areas - must have a … … (good at transmitting sound waves)
    • hard to see an … on these scans
  • What parts of the uterus can you see? what colours?
A
  • Transvaginal used for gynaecological assessment (much more detailed)
  • Transabdominal good for showing some areas - must have a full bladder (good at transmitting sound waves)
    • hard to see an ovary on these scans
  • 2 parts - Endometrium looks bright white, myometrium looks intermediate grey, junction not seen
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14
Q

What U/S is performed in men for prostate imaging and biopsy?

A
  • Trans-rectal U/S performed in men for prostate imaging and biopsy
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15
Q

Transabdominal Ultrasound

  • Transabdominal approach:
    • … frequency, … resolution image
    • Curved linear …
    • Better visualized with … bladder
  • Can see … and … views of organs and fetus
A
  • Transabdominal approach:
    • Lower frequency, lower resolution image
    • Curved linear transducer
    • Better visualized with full bladder
  • Can see coronal and sagittal views of organs and fetus
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16
Q

Transvaginal Ultrasound

  • … frequency, …. resolution image
  • … probe
  • Better visualized with … bladder
  • Can see … or … view of uterus
  • RULE OF THUMB: If possible attempt transabdominal before considering transvaginal to avoid a more … procedure
A
  • Higher frequency, higher resolution image
  • Endocavitory probe
  • Better visualized with empty bladder
  • Can see sagittal or coronal view of uterus
  • RULE OF THUMB: If possible attempt transabdominal before considering transvaginal to avoid a more invasive procedure
17
Q

Ante-natal U/S

  • Looking for … abnormalities
  • … rate
  • Calculating EDD - stands for…
A
  • Looking for Congenital abnormalities
  • Growth rate
  • Calculating EDD - Estimated date of delivery
18
Q

Foetal Measurements

•They can include the … rump length (CRL), … diameter (BPD), femur … (FL), head … (HC), … diameter (OFD), abdominal … (AC), and humerus … (HL), as well as calculation of the estimated fetal … (EFW).

A

•They can include the crown rump length (CRL), biparietal diameter (BPD), femur length (FL), head circumference (HC), occipitofrontal diameter (OFD), abdominal circumference (AC), and humerus length (HL), as well as calculation of the estimated fetal weight (EFW).

19
Q

Vascular anatomy of the pelvis

  • How do we image vascular system? (4)
A
  • MRI/MRA
  • Duplex U/S
  • CT angio
  • Angiography (Direct cathetier angio)
20
Q

Duplex U/S

  • Measure highest … in artery
    • ​Can assess f…, s…, an…, p…
    • Look for … flow (bruits) and post-stenotic …
A
  • Measure highest velocity in artery
    • ​Can assess flow, stenosis, aneurysm, plaque
    • Look for turbulent flow (bruits) and post-stenotic dilatation
21
Q

CT Angiogram

  • … intra-… contrast injected through peripheral cannula
  • Scan timed for maximum … enhancement
A
  • Iodinated intra-venous contrast injected through peripheral cannula
  • Scan timed for maximum arterial enhancement
22
Q

Catheter Angiogram

  • … … artery access, catheter into … or steered into selective artery.
  • … technique: needle puncture, insert guidewire, remove needle, advance catheter or sheath over wire.
A
  • Invasive femoral artery access, catheter into aorta or steered into selective artery.
  • Seldinger technique: needle puncture, insert guidewire, remove needle, advance catheter or sheath over wire.
23
Q

The … technique, also known as … wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs.

A

The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs.

24
Q
  • The … divides in the upper abdomen- splits into the common right and left … artery
  • Common … artery - mid pelvis - … iliac artery - blood supply to pelvis organs and glutaeal muscles and … iliac artery runs into groin - passes under the … ligament - as it passes under it becomes the common … artery to supply each leg
A
  • The aorta divides in the upper abdomen- splits into the common right and left iliac artery
  • Common iliac artery - mid pelvis - internal iliac artery - blood supply to pelvis organs and glutaeal muscles and external iliac artery runs into groin - passes under the inguinal ligament - as it passes under it becomes the common femoral artery to supply each leg
25
Q
  • Aorta bifurcates at level …
  • Vena cava divides at …
  • ​Right … crosses origin of Left …
A
  • Aorta bifurcates at level L4
  • Vena Cava divides at L5
    • ​Right CIA (Common iliac artery) crosses origin of Left CIV (Common iliac vein)
26
Q

May-Thurner syndrome

  • As Aorta dividing slightly … and … runs over top of vein - chronic high … pulsation of artery damages thin walled vein - scarring in some - if space of common … vein is compromised - narrowed - … may form within - bypass blood from left to right - into right iliac vein
A

Aorta dividing slightly higher and Right common iliac artery runs over top of vein - chronic high pressure pulsation of artery damages thin walled vein - scarring in some - if space of common iliac vein is compromised - narrowed - clot within - bypass blood from left to right - into right iliac vein

27
Q

Internal and External Iliac arteries

  • The external iliac artery passes … to the internal iliac artery and they both pass …
A

The external iliac artery passes anterior to the internal iliac artery and they both pass laterally

28
Q
A
29
Q

Internal Iliac Artery Anatomy:

  • Anterior and Posterior divisions:
    • Posterior division is …, … and superior …
A
  • Anterior and Posterior divisions:
    • Posterior division is iliolumbar, lumbosacral and superior gluteal
30
Q

Common femoral artery

  • Clinical problem - what is it? (after angiogram)
A
  • Angiogram - haven’t sealed the whole in artery properly - develop large pseudoaneurysm - bled from artery - sealed into this - not uncommon
  • Swelling in groin - get medical attention
31
Q

What is this angiogram called? (DSA)

A

DSA - Digital Subtraction Angiography - used for treatment of haemorrhage

32
Q

What has happened in this image? (… aneurysm)

A

Injection in buttock - punctured gluteal artery - warfarin so significant bleeding - Traumatic aneurysm of superior gluteal artery (pseudoaneurysm)

33
Q

This is a … MRI showing … pelvis

A

This is a sagittal MRI showing male pelvis

34
Q

This is a … MRI showing … pelvis

A

This is a sagittal MRI showing female pelvis

Year 2 Medicine (162 decks)

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