Lesson 4 (Part 3) Flashcards
What is the formula to find the size of the fibroid?
Length x width x height
What do we do if there are multiple fibroids?
We measure the largest 3
Why is it important to measure the submucosal fibroid?
Want to measure the submucosal fibroid because it is the one that is probably causing he bleeding
- even if it isn’t one of the biggest
How could you determine if the fibroid is truly originating from the uterus or if it is detached? (2)
- Use colour doppler
- looking for a connection - Apply pressure to help differentiate
- if it stays it is pedunculated (subserosa)
What happens to fibroids in postmenopausal women? (3)
- Rarely develop
- Usually decrease in size or stabilize in size
- Become calcified
When can fibroids in postmenopausal women increase?
If they are on hormone replacement therapy or tamoxifen
What can fibroids do during pregnancy or anovulatory cycles?
They can increase in size
What problems could occur with fibroid and pregnancy? (3)
- Location
- if in the cervix and it is large it can block the baby - Size
- bigger ones push on other structures - Submucosa fibroids can be the reason of miscarriages
What are complication associated with fibroids in general? (3)
- May outgrow blood supply
- ischemia and cystic degeneration - Degenerating or necrotic fibroids when outgrow blood supply
- areas of decreased echogenicity or cystic areas within calcifications - Pedunculated fibroids
- torsion can occur but RARE
What does colour doppler on fibroids usually demonstrate?
Peripheral flow
What are the advantages of using transabdominal to see fibroids? (3)
- Larger feild of view
- Better assessing for large fibroids
- Can be missed if just using transvaginal
What are the advantages of using transvaginal to see fibroids? (3)
- Good at detecting small fibroids
- Can tell the origin of large pedunculated, subserosal fibroids vs. adnexal masses
- Can see fundal fibroids on retroverted uterus
Are are 3 treatments of symptomatic fibroids?
- Uterine Artery Embolization
- air can be seen in fibroid 1 month later - Surgical treatment
- hysterectomy - Medical treatment
UAE
Uterine Artery Embolization
Lipoleimyomas
Uncommon and benign tumours
What are lipoleimyomas composed of? (3)
- Mature lipocytes
- Smooth muscle
- Fibrous tissue
What does lipoleimyomas look like sonographically? (3)
- Highly echogenic
- Attenuating mass within the myometrium
- Absence of colour flow within
Are lipoleimyomas usually symptomatic or asymptomatic?
Asymptomatic
What can lipoleimyomas be confused with?
Ovarian demoid
- cyst
Leiomyosarcoma
Rare and malignant tumours
What can leiomyosarcoma arise from
Leiomyoma
Are leiomyosarcoma usually symptomatic or asymptomatic?
Asymptomatic
- or uterine bleeding
What are the symptoms and appearances of leiomyosarcoma?
The same as fibroids
Where can you sometimes see leiomyosarcoma?
May see local invasion
- bladder
- rectum
- distant metastases
What is a clue with leiomyosarcoma (2)
- Rapid growth
2. Post menopausal growth
What is considered a common condition?
Adenomyosis
Adenomyosis
Endometrial glands and stroma within myometrium
What is adenomyosis associated with?
Adjacent smooth muscle hyperplasia
What are 2 forms of adenmyosis?
- Diffuse
2. Nodular
What makes adenomyosis more severe?
The presence of fibroids
- makes it difficult to diagnose
What does diffuse mean?
Widely scattered adenomyosis foci within the myometrium
- the whole thing
- more common
What does nodular mean?
Composed of adenomyomas
- circumscribed nodules
- little spots
