Pediatric Gyn Flashcards
what are some indication for Ultrasound in pede’s?
Ambiguous genitalia
abdominal mass
Vaginal bleeding or discharge
Precocious puberty
abnormal early development of sexual maturity
as US requuires a full bladder when should your pt’s drink?
Infants should be given a bottle around
30 minutes before the US
Older patients should drink 24 oz around
45-60 minutes before the US
*Take off your lab coat because a ‘white coat’ causes instant fear in children (some adults too)
wht Td should be used on pede’s?
what about protocol?
Transducer MHz should be as high as possible
Depends on the machine and size of the child
Curved 6 or 8 MHz & 8 MHz vector transducers on some
If the child is obese use a 5 MHz or lower
Speed & accuracy is very important since bladder control
is limited and an infant can void at any moment
Perform the same protocol as in adult pelvic patients
–Except transvaginal US is contraindicated in children
ped uterus to cervix ratio
Size ratio of uterus to cervix is variable on age and hormonal influence, if child has reached puberty
Sagittal image of normal newborn uterus shows the ratio of fundus (white arrow) to cervix (white arrowhead) length is 1:2.
Recall the uterus should NOT be larger than cervix until puberty
what going on w/ this 2 yo uterus?
it’s normal
Sagittal US through the bladder shows the uterus
devoid of an endometrial stripe and a fundus to cervix
(black arrows) ratio of 1:1
Transverse ovaries (white arrows) are small (less than 1 cm) in this child
which genital anomaly is Rare. Thought to be acquired secondary to torsion/necrosis in-utero
which is Associated with
Gonadal dysgenesis
Endocrine disorders
Intersex disorders
ovarian agenesis
ovarian hypoplasia
what syndrome (genital anomaly)
Complete or partial absence of 1 of the 2 “x” sex chromosomes: Gonadal Dysgenesis, Ovaries are deficient, Rudimentary gonads
is 45, X Karyotype or 46, XX Mosaicism. What does this mean?
turner’s syndrome
When an individual, who has developed from a single fertilized egg, has different chromosomal make-up (example; an individuals ovaries have abnormal numbered chromosomes 45 X while their blood & skin cells are all normal 46 XX)
what anomaly do these Clinical Findings indicate?
Short in stature, amenorrhea
Infantile genitalia, sparse pubic hair
Multiple congenital abnormalities
Web neck, shield like chest, arms turned out at elbows, heart
defects in ~50%, kidney abnormalities in ~60% (Horseshoe kidney, abnormal renal artery (affects blood pressure)
Research studies suggest that approximately 40% of these individuals may have some Y chromosomal material in addition to the one X chromosome. In other affected females, both X chromosomes may be present, but one may have genetic defects
turners syndrome
with regards to turners syndrome, Those fetuses that have ______________ renal agenesis could survive
while Those who have ________ renal agenesis would
die before or shortly after birth due to pulmonary
hypoplasia and severe oligohydramnios
unilateral
bilateral
what are the lab findings for turners syndrome?
what about ovary volume?
High gonadotropin level
Estrogen deficiency - Due to ovary having no primordial follicles and are often only a fibrous streak
FYI it is standard medical practice to treat girls affected
by Turner’s syndrome with estrogen to induce breast
development and other features of puberty if menses has
not occurred by 15 years
<1cm
‘’_____ is Usually based on an individuals self-concept & self identification as well as the role an individual assumes
in society. while ‘____ is ’Usually based on physical attributes
Gender, Sex
which genital anaomaly has the following:
A main indication for US of neonates if at birth
the ‘sex of the newborn’ cannot be determined
Typically an US is done while parents and
medical team is waiting for chromosome
karyotype & hormone level results
Early diagnosis is important to avoid serious
psychological disturbances in neonate
ambiguous genitilia
what should u look for in cases of ambiguous genitilia?
what should u look for on us?
Look for internal pelvic anatomy (uterus, vagina,
ovaries, testicles in the inguinal canal)
Image the adrenals and kidneys too for causes like
- – Congenital adrenal hyperplasia
- — Renal anomalies
\_\_\_\_\_ is a Term for “group of conditions where there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries)
it used to be called _________
intersex
Hermaphroditism
intersex disorder has to do w/ a ________ sensitivity.
what are the classifications w/i this disorder?
it is a X-Linked ______ condition resulting in a failure of
normal masculinization of the external genitalia
androgen
Complete, incomplete
recessive
People are genetically males with 46, XY karyotype: Resistant to androgens resulting in under masculinization
in embryology what affects intersex disorder?
Testis Determining Factor / Androgens
If male hormones are present an embryo with male anatomy/ structures develop
If there are no androgens or the embryo doesn’t have
androgen receptors the embryo will develop female anatomy /structures
what
1) Depends on how well the individual responds to
androgens
2) Can have either male or female external characteristics & parents raised the them accordingly
3) Clinically both male & females ‘body patterns’ have infertility issues (Males have impaired spermatogenesis)
4) Psychological morbidity is common (There is ‘grave emotional trauma’ at diagnosis)
the intersex disorder androgen insensitivity
name some clinical findings for androgen insensitivity in females
when should this condition be suspected?
Normal breast development
Abnormal uterus and/or vagina
Little to no pubic or axillary hair
Testes are abdominal (At risk for dysgerminoma or gonadoblastoma)
This condition should be suspected when the fetal
karyotype does NOT match the ‘sex’ seen on a fetal US
what constitutes someone as a true gonadal intersex?
female habitus below
Has both testicular and ovarian tissue - 46 XX, 46 XY, or 46 XX/46XY mosaicism karyotype
Uterus may or may not be present
Rare disorder, if not diagnosed in neonatal life it
usually manifests during adolescence
*Note they have both an unicornuate uterus (arrow),
ovary and a testicle (stars)
male habitus below
what is a 46 XX intersex known as?
what characteristics?
female pseudohermaphrodite.
Chromosomal female, has ovaries
Masculinized external genitalia ( Enlarged clitoris, Fused labia, Short, stock or square body shape, Evaluate for adrenal hyperplasia)
what is te 46 XY intersex
Male Pseudohermaphrodite
Under virilization of chromosomal male with feminized external genitalia
Testicles may be undescended & at risk of growing a malignancy (Body heat affects testicles adversely if over an extended time)
what ovarioan dysfunction is associated w/ pseudo precocious puberty?
what are they composed of?
are they common?
Granulosa-theca cell tumors are majority of the
cases (60% per Berman) (70-80% per e-medicine)
-These tumors are a feminizing neoplasm composed of
the granulosa cells of the Graafian follicle
- It is the most common of the hormonal tumors of the
ovaries - Hyperestrogenism
US Findings
Complex mass appears like
what is the Most common benign cystic
lesion of the vagina ( Rare in children)
gartners duct cyst
Remnant of the mesonephric duct
May be single or multiple
what is this
Anechoic mass with well defined margins & good sound transmission
Elongated
Location helps diagnosis
gartners duct cyst
what is pyosalpinx? what is it associated w/?
are there any symptoms?
common us findings?
Pus in the fallopian tube
what is a TOA? whats it associated w/ ?
US findings?
_____ is the Rare malignancy yet common ovarian mass in pediatric population
it is a Low grade malignancy, potentially curable due to the
fact it is very radiosensitive and Thought to be the counterpart of the testicular seminoma
Dysgerminoma
what is a form of malignant pthology that is a less common genital neoplasm
it is Highly aggressive germ cell tumor of vagina & cervix, Usually occurs by 3 years of age
and Clinically Simulates sarcoma botryoides & rhabdomyosarcoma
Endodermal Sinus Tumor
History is a newborn female with a pelvic
‘cyst’ seen on OB US exam
Describe these images
What is this condition?
Image ‘A’ was taken
inferior to Image ‘B’
Image A is a sagittal image showing a large,
conical, fluid-filled mass representing
obstructed vagina (v) behind bladder (B)
This is a Mid-line
Sagittal Image
Sagittal scan of pelvis
shows dilated uterine
cavity (U) filled with
echogenic debris
(blood). Fluid-debris
level is seen in dilated,
obstructed vagina (V)
