Lesson 4 (Part 4)

Question 1

What is the clinical presentation of adenomyosis? (6)

Answer 1

1. Nonspecific
2. Uterine enlargement
3. Pelvic pain
4. Dysmenorrhea
5. Menorrhagia
6. Seen more in women who have had children ***

Question 2

What is not well seen using transabdominal US?

Answer 2

Adenomyosis

- transvaginal is much better

Question 3

What are some sonographic features of adenomyosis? (9)

Answer 3

1. Diffuse uterine enlargement
2. Diffusely heterogeneous myometrium
3. Asymmetrical thickening of the myometrium
4. Inhomogeneous hypoechoic areas
5. Myometrial cysts
6. Poor delineation of endomyometrial border
   - thicker AP –> asymmetrical
7. Focal tenderness with the transvaginal transducer
8. Subendometrial echogenic linear striations
9. Subendometrial echogenic nodules

Question 4

Where is the usual location for adenomyosis?

Answer 4

Anterior fundal aspect

Question 5

What can be confused with fibroids?

Answer 5

Localized adenomyosis

Question 6

How does localized adenomyosis appear on US? (5)

Answer 6

1. Inhomogeneous
2. Circumscribed areas within myometrium
3. Poor delineation of an endomyometrial border
4. Thicker AP
5. Asymmetrical

Question 7

What are 2 modalities that are good at diagnosing adenomyosis?

Answer 7

1. MRI

2. US

Question 8

AVM’s

Answer 8

Arteriovenous malformations

Question 9

Arteriovenous malformations

Answer 9

Vascular plexus of arteries and veins with no capillary network
- rare lesions

Question 10

What are most causes of AVM’s acquired by? (3)

Answer 10

1. Pelvic trauma
2. Surgery
3. Gestational trophoblastic neoplasia

Question 11

When is AVM’s usually diagnosed? (2)

Answer 11

1. Postabortion

2. Postpartum periods

Question 12

What is a symptom of adenomyosis?

Answer 12

Severe vaginal bleeding

Question 13

D&C

Answer 13

Dilation and curettage

Question 14

Dilation and curettage

Answer 14

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

Question 15

What can D&C do?

Answer 15

Worsen bleeding and lead to hemorrhages

Question 16

What is the sonographic appearance of AVMs? (4)

Answer 16

1. Multiple tortuous anechoic structures
2. Subtle myometrial heterogeneity
3. Myometrial or endometrial mass
4. Coloured mosaic pattern

Question 17

What characteristics of spectral doppler does AVMs have? (3)

Answer 17

1. High velocity
2. Low resistance arterial flow
3. High velocity venous flow
   - more like an artery

Question 18

RPOC

Answer 18

Retained Products of Conception

Question 19

GTN

Answer 19

Gestational trophoblastic neoplasia

Question 20

What are 3 different diagnosis for AVM?

Answer 20

1. RPOC
2. GTN
3. Subinvolution of placental bed

Question 21

What helps to distinguish AVMs?

Answer 21

Negative hCG

Question 22

What is the treatment for AVM? (2)

Answer 22

1. Wait to see if resolves on its own
   - it may not be an AVM
2. If severe bleeding occurs then you need immediate treatment
   - or you will get embolization

Question 23

Monckeberg’s Arteriosclerosis

Answer 23

Form of arteriosclerosis where calcium deposits are found in the muscular middle layer of the walls of arteries

Question 24

Where does monckeberg’s arteriosclerosis occur? (3)

Answer 24

1. Peripheral arteries
2. Coronary arteries
3. Genital organ arteries ***

Question 25

What is the cause of monckeberg’s arteriosclerosis ?

Answer 25

Not well known

- commonly no S/S

Question 26

What is monckeberg’s arteriosclerosis associated with? (4)

Answer 26

1. Diabetes
2. Chronic kidney disease
3. Lupus
4. Chronic inflammatory conditions