Module 3 : Extra Pelvic Pathology Flashcards
10 common metastatic sites for ovarian cancer
- pleura
- diaphragm
- liver
- serial bowel implants
- colon
- nodes
- ovaries
- omentum
- stomach
- pelvic peritoneal implant
vaginal hymen
- septum remains in the lumen of the vagina between the ureogenital sinus and upper vagina
imperforate hymen
- occurs if the hymen does not rupture causing hydrocolpos or hematocolpos
hydrocolpos
- fluid in vagina
- occurs before puberty
- retention of vaginal secretions
- less severe
hydrometrocolpos
- before menses or after menopause (stenotic cervix)
- secretions in uterus and vagina
- more severe
hematocolpos
- after puberty (should be getting menstual cycle but no blood)
hematometra
- retention of blood in uterus
hematometrocolpos
- blood in uterus and vagina
sonographic appearances of hemato and hydrocolpos
- identify level of obstruction
- evaluate the echogenicity
+ hypo echoic = fluid
+ hyperechoic and debris = blood - look for fluid fluid levels
gartner duct cysts
- cysts along the vagina
- mesonephric duct remnants
- single or multiple
- lateral or anterolateral
- asymptomatic and incidental
vaginal carcinoma
- not used in diagnosis
- used to help stage
- assess pelvic spread or distal metastasis
nabothian cysts
- retention cysts
- common
- multiple
- entrapped cervical secretions
carcinoma of the cervix
- Dx clinically = Pap smear
- cancer of cervix may cause obstruction
+ uterus = hematometra
+ renal = hydronephrosis - sonography to help stage
cervical cancer risk factors
- infection from HPV
- early sexual activity
- multiple sexual partners
- low socio-economic status
- smoking
- use of oral contreceptives
- weakened immune system
- DES in utero
sonographic findings of cervical carcinoma
- hematometra from cervical stenosis
- multiple cystic areas within a solid cervical mass
- bulky cervix
- irregular cervical borders
- mass extending from cervix to pelvic sidewalls
- tumor invasion of bladder
- hydronephrosis
- liver mets and para-aortic nodes
incompetent cervix
- may cause preterm labor or delivery
- cervical effacement (shortening) in 2nd or 3rd trimester
- best assessed translabial or EV
causes of incompetent cervix
- trauma
- DES - t shaped uterus
- idiopathic
two types of adnexal pathology
- endometriosis
- pelvic inflammatory disease (PID)
+ acute and chronic
what is endometriosis
- growth of endometrial tissue outside uterine cavity
- cyclical tissue will shed with menstraution causing incredible pain
- only found in reproductive age group (hormones stimulating)
- can cause adhesions (bad bad)
two types of endometriosis
- internal
+ adenomyosis - external
+ endometriosis
4 places endometriosis usually occurs
- ovaries
- fallopian tubes
- broad ligament
- pouch of Douglas
- FIRST PLACE IN RECTOVAGINAL CCANCAL
symptoms of endometriosis
- dysmenorrhea
- dysparunia
- infertility
- menorrhagia
- may have palpable mass
+ endometrioma - fixed retroverted uterus
- no free fluid
sonographic appearance of endometriosis
- usually difficult to see
- may have endometrioma (chocolate cyst)
sonographic appearance of endomtrioma
- well defined
- predominantly cystic mass
- low level echoes
- may see fluid-fluid levels
differential diagnosis of endometrioma
- hemorrhagic ovarian cyst
- ovarian cyst adenoma
- tuba-ovarian abscess
treatment of endometriosis
- drugs (hormones)
- laser surgery
- hysterectomy and oophrectomy
pelvic inflammatory disease
- infection of female genital tract
causes of PID
- STI = gonorrhea or chlamydia
- pyogenic
+ IUCD
+ surgery
+ postpartum
+ crohns disease
symtoms in stage 1 PID
- asymptomatic or vaginal discharge and tenderness
- endometritis
symptoms in stage 2 PID
- FEBRILE
- acute pelvic pain
- abnormal vaginal bleeding
- may develop hydrosalpinx
symptoms in stage 3 PID
- TOA stage (tubal ovarian abscess)
- acute and pain
- INCREASED WBCS
- could develop Fitzhugh Curtis syndrome
Fitzhugh Curtis syndromes
- perihepatitis- inflammation of liver capsule
- pain on inspiration
- RUQ pain
- small accesses on liver capsule - may lead to adhesons
- increased liver enzymes
salpingitis
- walls become thickened and oedematous
- if tubes are blocked PYOSALPINX (pus) occurs
- once treated infected material resorbed and chronic result is HYDROSALPINX
acute PID sonographic appearance stage 1
- endometritis
- thick endo
- fluid in canal
- or normal cancel
- difficult to DX on US
acute PID sonographic appearance stage 2
- pyosalpinx
- hypo echoic s shaped Fallopian tubes with low level echoes
- Fallopian tube walls are smooth
acute PID sonographic appearance stage 3
- multilocular mass
- irregular borders
- fluid-fluid levels air within mass, make sure cystic loops do not move
chronic PID on ultrasound
- distended s shaped tubes
- thin walls
DDX of chronic PID
- difficult to differentiate from ovarian cyst or small cyst adenomas
hermaphroditism
- possessing both male and female sex traits +/- ambiguous genitalia
- two types
+ true
+ pseudo
true hermaphrodite
- POSSESSING BOTH OVARIAN AND TESTICULAR TISSUE
- infertile
- increased risk of cancer in gonads
- due to fusion of 2 heterozygous twin zygotes right after fertilization
pseudo hermaphrodite
- possessing chromosomes of one sex but develop sex traits of opposite sex
- male and female
male pseudo hermaphrodite
- genetically male (testes)
- female characteristics
- may be due to lack of androgens
female pseudo hermaphrodite
- genetically female (ovaries)
- male characteristics
- due to excessive androgens
other areas to look when pelvic pathology is identified
- kidneys for obstruction
- liver for metastatic disease
- lymphadenopathy
- free fluid/ascites
fallopian tube carcinoma
- serous tubal intraepithelial tubal carcinoma
- STIC
- thought many ovarian cancers begin in the fimbriae of Fallopian tube
- most are adenocarcimonas
- minority are endometroid and clear cell
sonography of tubal cancer
- very similar to ovarian cancers
- complex largely solid mass with cystic components
- highly vascular
- sausage shaped
- most cases ovary is not seen
