Lesson 4 (Part 4) Flashcards
What is the clinical presentation of adenomyosis? (6)
- Nonspecific
- Uterine enlargement
- Pelvic pain
- Dysmenorrhea
- Menorrhagia
- Seen more in women who have had children ***
What is not well seen using transabdominal US?
Adenomyosis
- transvaginal is much better
What are some sonographic features of adenomyosis? (9)
- Diffuse uterine enlargement
- Diffusely heterogeneous myometrium
- Asymmetrical thickening of the myometrium
- Inhomogeneous hypoechoic areas
- Myometrial cysts
- Poor delineation of endomyometrial border
- thicker AP –> asymmetrical - Focal tenderness with the transvaginal transducer
- Subendometrial echogenic linear striations
- Subendometrial echogenic nodules
Where is the usual location for adenomyosis?
Anterior fundal aspect
What can be confused with fibroids?
Localized adenomyosis
How does localized adenomyosis appear on US? (5)
- Inhomogeneous
- Circumscribed areas within myometrium
- Poor delineation of an endomyometrial border
- Thicker AP
- Asymmetrical
What are 2 modalities that are good at diagnosing adenomyosis?
- MRI
2. US
AVM’s
Arteriovenous malformations
Arteriovenous malformations
Vascular plexus of arteries and veins with no capillary network
- rare lesions
What are most causes of AVM’s acquired by? (3)
- Pelvic trauma
- Surgery
- Gestational trophoblastic neoplasia
When is AVM’s usually diagnosed? (2)
- Postabortion
2. Postpartum periods
What is a symptom of adenomyosis?
Severe vaginal bleeding
D&C
Dilation and curettage
Dilation and curettage
A surgical procedure involving dilatation of the cervix and curettage of the uterus, performed after a miscarriage or for the removal of cysts or tumours
What can D&C do?
Worsen bleeding and lead to hemorrhages
What is the sonographic appearance of AVMs? (4)
- Multiple tortuous anechoic structures
- Subtle myometrial heterogeneity
- Myometrial or endometrial mass
- Coloured mosaic pattern
What characteristics of spectral doppler does AVMs have? (3)
- High velocity
- Low resistance arterial flow
- High velocity venous flow
- more like an artery
RPOC
Retained Products of Conception
GTN
Gestational trophoblastic neoplasia
What are 3 different diagnosis for AVM?
- RPOC
- GTN
- Subinvolution of placental bed
What helps to distinguish AVMs?
Negative hCG
What is the treatment for AVM? (2)
- Wait to see if resolves on its own
- it may not be an AVM - If severe bleeding occurs then you need immediate treatment
- or you will get embolization
Monckeberg’s Arteriosclerosis
Form of arteriosclerosis where calcium deposits are found in the muscular middle layer of the walls of arteries
Where does monckeberg’s arteriosclerosis occur? (3)
- Peripheral arteries
- Coronary arteries
- Genital organ arteries ***
What is the cause of monckeberg’s arteriosclerosis ?
Not well known
- commonly no S/S
What is monckeberg’s arteriosclerosis associated with? (4)
- Diabetes
- Chronic kidney disease
- Lupus
- Chronic inflammatory conditions
