Module 4: Gynae/ Obs / Breast Flashcards
how does a uterus change shape over time
infant - larger than expect. large cervix
prepuberyty - elongates
puberty - pear
Tuners syndrome gonads
Streaky ovaries and pre-puberty uterus
mullerian ducts make
uterus and upper 2/3 of the vagina
fallopian tubes
what makes the bottom 1/3 f the vagina
the urogenital sinsus
Urogenital sinus makes
Prostate
Lower 1/3 of the vagina
uterus cleavage happens in what direction
bottom to top
three types of uterine failure
failire to form
fail to fuse
fail to cleave
Uterus didelphys is what
seperate uterus . fail to fuse.
vaginal ax of uterus didelphys
vaginal septa
feature of septate uterus
septum remains between the two uterine cavities
mullerian agenesis is called what syndrome
Mayer Rokitansky Kuster Hauser Syndrome
Features of mullerian agenesis
vaginal atresia
absent uterus / abnormal
normal ovaries
(often have kidney issues)
mullerian agenesis is a type of what uterine malfunction
failire to form
unicornate uterus is what type
and why is it painful
failure to form
endometrial tissue inside non communicating horn(hemi uterus)
complete uterine duplication is called
Uterus didelphys
DES related anomaly
T shaped ueterus from drug.
and vaginal clear cell carinoma
failure to cleave results in what
thick septate
biconruate vs septate
fundal contour is heart shaped in bicornuate
contraindications to salphyngogram
bleeding
infection
pregnancy
allergy
contraindications to salphyngogram
bleeding (menstruation)
infection
pregnancy
allergy
contraindications to salphyngogram
bleeding (menstruation) do d7.
infection
pregnancy
allergy
appearance of salpingitis isthmica nodosa
nodular scarring of fallopian tubes
features of endometritis
post birth
spectrum of pid
features of endometritis
post birth
spectrum of pid
thickened endometrial cavity
endometritis can progress to having gas and pus and is called
pyometrium
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
endometritis can progress to having gas and pus and is called
pyometrium
most common location of fibroids
intramural
peripheral popcorn calcifcaiton of uterin fibroid seen on which modality
plain film
fibroids on mri
T1 dark (to intermeidate)
T2 dark
variable enhacnement
what are the 4 tpyes of degeneration of uterine fibroids
Hyaline
Red 9carneous)
Myxoid
Cystic
hyaline degeneration
MRI findings and why
T2 dark
outstrips blood supply.
proteinacious tissue.
T2 dark, no enhacnement
Red (carneous) degeneration of fibroid
MRI and why
peripheral T1 high signal .
occurs in pregnancy, from venous thrombosis.
myxoid degenerative change apperaance on mRI
T2 bright.
what is the feature of a leiomyosarcoma ?
rapid growth and necrosis
what is adenomyosis
endometrial tissue has entered the myometrium layer.
causes enlarged uterus
thickening of the junctional zone of uterus to more than 12mm…
with T2 bright cystic foci…
adenomyosis
post menopausal endometrial thickening
what measuremnt is concerning and require sampling
5mm
what type of tumour will thicken the endometrium and why
Granulosa cell tumours
- oestrogen secreting
Hereditory nonpolyposis colon cancer
what effect does tamoxifen have on the uterus
increases endometrial cancer risk due oestrogen effect on the uterus
depsite being a blocker of estrogen in the breasat
tamoxifen endometrial thickness gets a pass up to
8mm
endometrial fluid in a post menopausal mass means
cervical stenosis or an obstructing mass
cervical cancer - staging for surgery
IIA or below is surgery
IIb cervical cancer (parametrial invasion) get
chemo and radiation
what is the parametrium ?
fibrous band between the supravaginal cervix and bladder
primary vaginal masses
what types of cancer
clear cell adenocarcinoma
rhabdomyosarcoma
most common cancer of the vagina
squamous cell carcinoma
Who gets vaginal celar cell ADENO carcinoma
mothers took DEX
T shaped uterus
Vaginal rhabdomyosarcoma has what age distribution
2- 6
14 - 18
metastatic spread to the upper vagina wall
anterior vs posterior
anterior from genital
posterior from GI tract
nabothian cysts are found where?
Cervix
epithelium plugging of mucous glands
Gartner duct cyxsts are found where
anterior lateral wall of vagina.
due to incomplete regression of the wolfian ducts
skene gland cysts are found where
periurethral glands
ovaries
haemorrage in a cystic mass means it is
benign
Normal vs abnromal ovary size cut off
15ml
post menopause 6ml
dominant follicle can be what size?
2cm
what is an cumulus oophorus?
cells that protrude into a mature dom follice, imminent ovulation
what does clomiphene citrate do?
forces matuation of multiple bilateral ovarian cysts
theca lutein cyst will have what appearance
spoke wheel from multiple large cysts
what causes theca lutein cysts
overstimulation of b-HCG
what are the sequelae of ovarian hyperstimulation syndrome?
theca lutein cysts, ascites, pleural effusion event pericardial effusions.
hypovolaemic shock
why do you do a PET in the first week of the menstrual cycle?
beacuse ovaries can be on HOT depending on cycle
menopause is defined as
1 whole year without menses
postmenoausal ovary abnormal is when its above normal limit orrrrrr
twice the size of the other one
PET ovaries on post menopausal is
ABNORMAL
ovarian cyst rules
under3cm simple - nothing
3-5cm - report but no f/u
>5cm - described and f/u considered
>7cm MRI or surgical referral
get an US if found on ct/mri
what are the ovaria sinister 6
physio follicles
corpora lutea
haemohagic cysts
endometriomas
benign cystic teratomas
polycystic ovaries
a peristent cyst may be called….
a nonfunctioning cyst
normally change after 6 weeks with hormones
ring of fire seen around ovarian lesion
corpus luteum
but could also be ectopic pregnancy
endometriosis triad
infertility
dysmenorrhea
dyspareunia
what will an endometrioma look like
rounded mass
homogenous low level internal echoes
increased through transmission
echogenic foci on wall
endometrioma can (1% ) become what cancer
note need to be like 9cm and older than 45
endometrioid or clear cell carcinoma
what is the most sensitive imaging feature on MRI for the diagnosis of malignany in an endometrioma
enhancing mural nodule
endometrioma on MRI
T1 bright -blood
T2 - dark (iron)
fat sat, won’t suppress (not a teratoma)
hameorrhagic cyst
lacy fishnet appearance
classsic or having bled into it
different apeparance ot an endometrioma
haemorrhagic cyst in early post menopause ladies?
postmenopausal women may ovulate
can follow up in 6 weeks as haemorrhagic cysts should disappear
Dermoids affect what age?
20s to 30s
what does tip of the icerberg sign mean?
US, absorbed by the mass at the top
dermoid on MRI
T1 and fat sat b ehaviour
T1 bright - fat
supress
T2 bright
haemorrhagic cysts and endometriomas dont suppress
Endometrioma on MRI
T1 bright
not suppress on fat sat
T2 dark
dermoids can (1%) turn into what cancer with what risk factors
squamous cell CA
10cm +
older than >50
PCOS on US how many cysts
10 or more
do ovaries have to be enlarged in PCOS
no
where in the ovary are cancers found
within ovary
outside often benign
what measurement is thick counted at for septations
3mm
nodule with flow or mutliple thin or thick speations need to
refer to surgeons
Solid nodules without flow, why do we need an MRI
to ensure not a dermoid plug
if not to surgeons
appearance of serous tumours?
unilocular
few septations
can be bilateral
papillary projections suggest malignancy
mucinous ovarian (cystadencarcinoma) appearance
what can you get from this
large
multiloculated with thin septa
can get pseudomyxoma peritonei
risk factor for mucinous ovarian cystadencarcinoma
smoking
endometroid ovarian cancer
25% will have concomitant
endometrial cancer
(ovary is the met)
ovarian mass and endometrial thickening can be caused by what two conditions
Endometroid cancer
Granulosa Theca Cell Tumour
adult big fucking mass
differentials can be
Ovarian masses
desmoids (gardner syndrome)
sarcomas
ovarian fibroma on US
hypoechoic and solid
MRI findings of ovarian fibroma
T1 and T2 dark
T2 dark rim
what is Meigs syndrome
Ascites
pleural effusion
benign ovarian tumour
what’s fibromatosis
tumor LIKE enlargement of ovaries.
omental fibrosis and sclerosing peritonitis.
Brenner Tumour is also called
Ovarian transitional cell carcinoma
struma ovarii are a subtype of
teratoma
imaging appearance of struma ovarii
multilocualar
cystic mass
INTENSE solid component enhacnes
Low T2 in cyst (thick colloid)
struma ovarii contain what kind of tissue
THYROID
krukenburg ovary tumour
mets from GI
ovarian torsion normally due to
cyst or tumour causing the torsion
Imaging features of torted ovary
Unilateral, enlarged (over4cm)
Mass on the ovary
peripheral cysts
free fluid
lack of arterial or venous flow
what is the significane of flow in a large ovary considered for torsion
dual blood supply
so can be torted and still have blood flow
PID infeciton types
gonorrhea or chlamydia
PID imaging of utersu
undefined.
salpinx
paraovarian cyst is caused by what
congenital remnant from the wolffian duct
ovarian vein thrombophlebitis can affect
postpartum women
acute pelvic pain and fever!
CT appearance of ovarian vein thrombophlebitis
enhancgin wall and low attenuation thrombus in the expected location of the ovarian vein
can move on to a pulmonary embolus
how is a peritoneal inclusion cyst formed?
adheisions surround an ovary which has unresorbed secretions causing a passive mass
Gestational trophoblastic disease causes a rise in what homrone and subsequent symptom
bHCG
vomitting
three types of getsationaltrophoblastic disease
Hydatidiform mole/
invasive mole
partial and complete
choriocarcinoma
what is the difference betweena complete mole and partial mole
comple
- involves entire placenta. diploid karyotype. no fetus.
partial
- partial placenta. may see fetal parts. diffuse anechoic lesions. triploid
what is an invasive mole
invades the myometrium
choriocarcinoma. how does it spread
locally then by blood.
US appearance of choriocarcinmoa
highly echogenic solid mass
treat choriocarcinoma
methotrexate
what is the intradecidula sign a sign of
early pregnancy
signs the yolk sac has gone bad
too big 6mm
too small 3mm
solid or calcified
what is the double bleb sign
earliest view of embryo which is flat between the
amniotic sac
yolk sac
what is meant by an anembryonic pregnancy
gestation al sac without an embryo
causes of anembryonic pregnancy
very early pregnancy
non-viable pregnancy
what is a pseudogestational sac
in ectopic pregancy
endometrium is pumped up from the hormones
List some criterie for fetal demise
diagnostic
> 7mm crown-rump length + no heartbeat
no embryo + sac diameter of >25mm
No embryo + heartbeat > 11days after a scan that showed a gest sac/yolk sac
no embryo with heartbeat >2wk after a scan that showed a a gestation sac with no yolk sac
list some criteria for suspicious for pregnancy failure
no embryo and >6wks from last period
no embryo with sac 16-24mm
no embryo with heartbeat - 13 days post scan gest sac without yolk sac
no embryo with heartbeat 10 days after a scan that showed a gest sac with a yolk sac
what is subchorionic haemorrhage
heamorrhage around the chorion. more haemorrhage risks aboriton.
a little haemorrhage is common
what are the high risk factors for ectopic pregnancy
PID hx
tubal surgery
endometriosis
ovulation induction
previous ectopic
use of an IUD
which part of the fallopian tubes do ectopics normally happen in?
isthmic portion
what is the sing to look for on US of ectopic pregnancy
Tubal ring sign
four standard measurements of fetal growth are
Biparietal at thalamus, outer to inner.
head circumference
abdominal circumference - level of umbilical vein and left portal vein
femur length - not including epiphysis
age in the first trimester is made from the
crown rump length
second and third gestational age is…
composite GA (BPD, HC, AC, FL) as discussed above
Readings suggestive of an IUGR
weight below 10th percentile
FL / AC > 23.5
Umbilical artery systolic /diastolic ratio > 4.0
IUGR is categorised into two groups which are
symmetrical
asymmetricla
asymmetrical IUGR
head sparing, 3rd trimester.
High BP
Severe malnutrition
Ehlers Danlos
Symmetric IUGR
global growth restriction does not spare the head and all of pregnancy.
Casued by TORCH, EtoH, anemia, chromsomonal abnormality
issues
THE RESISTANCEin the umbilical artery should WHAT with gestational age
decrease
why can T1 daibetic mothers also have small babies
hypoxia from microvascular disease in the placenta
ppost natal complications of macrosomnia
neonatal
hypoglycaemia
meconium aspiration
Erbs palsy damages what nerve roots
C5 6
amniotic fluid isurine after how many weeks
16
Amniotic fluid index (AFI)
abnormal is
<5 (Oligohydramnios)
> 20(Polyhydramnios)
Normal fetal lungs
look like liver
Normal midgut henriation happens around what time?
9 - 11 weeks
placentra too thin - size is
<1cm
placenta too thick - size is
> 4cm
causes of thin placenta
Maternal DM
Trisomy 13 or 18
Toxemia of pregnancy
htn
causes of placenta too thick
fetal hydrops
Mat DM
maternal anaemia
congenital fetal cancer
congenitla infeciton
placental abruption
Types of variant placental morpholog y
Bilobed
succenturiate lobe - accessory lobe
circumvallate placenta - rolled edges
Risks of bilobed placenta
T2 Vasa previa
PPH
velamentous insertion of the cord
Risk of succenturiate lobe
T2 vasa previa, PPH
risk of circumvallate placenta
placental abruption
iUGR
what is placenta previa
low lying placenta
painless vaginal bleeding in third trimester.
US needs to be empty bladder
what time can you see the placenta?
8 weeks
how to discern placental abruption from fibroids/myometrial contracitons
disruption of the retropplacental complex of blood vessels vs displacing the complex
types of placenta insertion
Accreta - into endometrium
increta - into myo
percreta- into serosa
placenta chorioagnioma - how are they diagnosed
hamartoma of the placenta
have foetal circulation.
hypoechoic near cord insertion.
if big >4cm cna sequester platelets
How to discern a placental chorioagnioma vs placental hematoma?
pulsating doppler flow in chorioangioma
hematoma does not have doppler flow
what are the vessels of the normal cord
2 arteries and 1 vein
risk factors for single artery in umbilical cord
material diabetes
twins
marginal cord inseriotn
seen more in twins
nearly velamenrtous insertion:
cord is more to the side and inserts placenta through the membranes
what is vasa previa
fetal fessels cross the internal cervical os
What are the two types of vasa previa
1 and 2.
T1 - velamentous cord inseriton
T2 - bilobed placenta or succenturiate lobe
nuchal cord
around the neck
umbilical cord cysts
peripheral name vs central name
peripheral - omphalomesenteric
central - allontoic cyst
US findings for Downs
Congenital heart disease (VSD)
Duodenal atreisa
Short femur
echogenic bowel
choroid plexus cyst
nuchal translucency
nuchal fold thickness
echogenic focus in cardiac ventricle
nuchal tranlucency measurement
> 3mm is abnromal.
what is amniotic bands syndrome
fetus hasn’t stayed in the amniotic cavity.
gone into the fibrous and stiky chorionic cavity - amputated limbs
Causes of hydrops
TORCH
Turners
Twin related stuff
Alpha thalassemia
US - pleura effusion, pericardial effusion, sub cut edema.
what is the big three appearance on US of hydrops
Body wall edema
pleural effusion
ascites
Lemon and banana signs are seen in what conditions
Spina bifida
chiari II
facial clefts are associated with…
30% of the time chromosomal abnormality
a posterior neck mass looking complex in a fetus
cystic hygroma
cystic hygroma are ax with
Turners and downs
Ventriculomegaly. size
ventricular atrium diameter > 10mm
most common neural tube defect is
anencephaly
all kids with congenital diaphragmatic hernia will also have
malrotation
fetal heart rate parameteres
100 - 180
normal fetal bowel is isoechoic to the
liver
ddx for hyperechoic bowel in fetus
CF
Trisomies
Viral infections
Bowel atresia
most common tumour of the fetus/infant
sacrococcygeal teratoma
short femur think of
Downs
Skeletal dysplais a
define incompetant cervix
shortened endocervical distance of < 2.5cm.
risk premature delivery
maternal hydronephrosis, how common is this?
80% get it
mechanical
mostly on the right
what things grow in pregnancy
splenic artery aneurysms
renal amls
fibroids
Uterine rupture happens where and when
Where - location of prior C section
When - 3rd trimester
HELLP syndrome causes what
raised LFT
low platelets
haemolysis.
severe form of pre-eclampsia
what is peripartum cardiomyopathy?
dilated myopathy in the last 1 to 5 months
Cardiac MRI findings in peripartum cardiomyopathy are
depressed function
non-vascular territory subepicardial late Gd enhancement
What happens in sheehans?
large volume haemorrhage with the enalrged pituitary which happens in pregnancy
MRI appearance of sheehans
Acutely bright
late may have an enhancing rim sign
Ovarian vein thrombophlebitis risk factors are
c section
endometritis
ovarian vein thromboplhebitis - which side is afffect more?
right side more
Retained products of conception
associations
MTOP
Second Trimester miscarriage
placenta accreta
US appearance of endometiritis
thickened
heterogenous endometrium with or without fluid
with twins what is the percentage difference between them that would be considered a significant difference
15%
Twin Twin transfusion occurs in which types of twin?
Monochorionic twins with a vascular communication in the placenta
What are the outcomes for Monochorionic twin twin transufison
skinny and chubby
skinny is “stuck to the wall of the uterus.”
chubby can get hydrops and die.
skinny gets high resitance umbilical artery spectrum
What happens in twin reversed arterial perfusion syndrome ?
pump twin pumps blood into the other twin. due to intraplacental shunting
get an acardiac twinv
of twins, if one dies which part of the pregnancy is this more of an issue in
later
What is twin twin embolization syndrome ?
embolized necrotic dead fetus transferred to the living fetus.
DIC, ischaemia, infarction
twin twin embolization syndrome can only happen in what kind of pregnancy
monochorionic
the nipple is made of what tissue
smooth muscle
how many ductalvopening on a nipple
5-10
nipple inversion vs retraction>?
inversion - invaginates
retraction - pulled back
Nipple on contrast MRI does what
enhance
what are the ligaments taht hold the breasts up called
Coopers ligaments
what happens in architectual distoraiton?
Its coopers ligaments being distorted / straightened
especially in surgical / radial scars and IDC
what to think of asymetrical brast
normal
unless new.
invasive lobular breast cancer can shrink a breast
a terminal lobule ductal unit is significant in cancer for what reason
a lot of cancers start here
what journey does milk take anatomically
Temrinal duct lobule unit
lobule
major duct
lactiferous sinus
which type of calcifications within the ducts should be a concer
ones that follow the ducts.
linear / segmental
blood supply of breast tissue
internal mammory artery (60%)
LATERAL THORACIC INTERCOSTAL PERFORATORS
BREAST LYMPH
97% TO THE AXILLA
rest to internal mammory
mets to the internal lymph nodes will be from
a medial mass
lymph node levels what are they
1 - 3, rotternode
lateral to pec minor
under pec minor
media to pec minor
rotter node - between the pec maj and min
sternalis is only seen on which breast mammography view
CC only
nevel mlo
estrogen effect in puberty on the duct
elongate and branch
progesterone effect in puberty on lobules
proliferate
when are the follicular and luteal phases of the cycle
follicular 7-14
luteal 15 - 30
Estrogen dominates in which phase
follicular
Progesterone dominates in which phase?
luteal
breast changes in pregnancy
tubes and ducts prolierate
breast gets denser
hypoechoic on US
brast change perimenopausal
shortening of the follicular phase - more progesterone
more breast pain
more fibrocystic change
more breast cyst formation
menopause breast changes
lobules go down
ducts stay or ectatic.
fibroadenomas will degenerate with the lack of estrogen
breast changes with HRT
painful breast
more dense
fibroadenomas can grow
what can cause the breasts to be dense on imaging
prolcatinoma
antipsychotic mds
galactocele can appear as what
fat fluid level behind the areolar
posterior nipple line needs to reach what to be considered adequate
pec major
why would a woman have an LMO rather than an MLO
kyphosis
pectus excavatum
avoid a pacemaker or line
when to use an LM or ML?
aim is to move the insepected portion closer to the receptor.
Item on lateral edge do an ML.
if on medial edge do an LM.
three tpyes of calc seen on breast imaging
how to call them
artifact
benign
suspicious
classic artefacts mimics of calc
deodrant
zinc oxide
metaliic
breast calc terminology
BENIGN END
scattered
regional
grouped
linear
segmental
CONCERNING
what are dermal calcification
found anywhere women sweat
how to confirm dermal calc
ask for tangential view
feature of vascular calcification
linear paraller
popcorn calc associate dto
degenerating fibroadneoma
secretary calc have what buzzword
cigar shaped with a lucent centre
why do people get secretary clac
duct has involuted so are there in people 10 -20 years after the menopause
what are eggshell calc related to
fat necrosis from trauama
dystrophic calc will apeear
bigger than fat necrossi
but aetioogy is the same
tea cupped calc
firocystic change
posterior nipple line should be what distance on the
1cm
features of endometritis
post birth
spectrum of pid
thickened endometrial cavity
