Pediatric Pelvic Sonography

Question 1

Describe the sonographic findings in a newborn female.

Answer 1

• cervix twice the length of uterine body (cervix 2/3, body 1/3)
• hyperechoic endometrium (due to maternal hormone influence in utero)
• total length approximately 3cm, AP is 0.5-1cm
• ovaries may be found anywhere between lower poles of kidneys and the true pelvis

Question 2

Describe the sonographic findings in an infant female after 2-3 months of age.

Answer 2

• 2.5-3cm total length - with cervix and body equal in length (cervix 1/2, body 1/2)
• endometrial stripe is usually not delineated
• maintains infantile appearance until age 7
• small cysts may be seen on ovaries, in ovaries, usually <9mm, but may be as large as 17mm

Question 3

When does follicular development occur?

Answer 3

prior to menarche (+/- ovulation)

Question 4

Describe the sonographic findings of the uterus and ovaries at puberty.

Answer 4

• uterus gradually increases in length (to 5-7cm)
• body to cervix ratio becomes 3:1 (2/3 body, 1/3 cervix0
• endometrium echogenicity and thickness vary with menstrual cycle
• ovaries increase in volume and vary with menstrual cycle

Question 5

What are the indications for pediatric imaging?

Answer 5

• r/o ovarian cyst or complications of them
• assess ovaries when polycystic ovarian disease is suspected
• r/o ovarian neoplasms
• r/o congenital uterine anomalies
• determine presence or absence of uterus and vagina in newborns with ambiguous genitalia
• evaluate uterus and ovaries in patients with precocious puberty
• r/o hydro- or hematocolpos

Question 6

What is precocious puberty?

Answer 6

onset of secondary sexual characteristics prior to age 8

Question 7

What is true precocious puberty?

Answer 7

resulting from an early but normal pattern of gonadotropin secretion from the pituitary

Question 8

What may true precocious puberty be secondary to?

Answer 8

• hypothalamic disease

- congenital adrenal hyperplasia

Question 9

True precocious puberty is _______ in greater than 80% of cases

Answer 9

idiopathic

Question 10

What is precocious pseudopuberty caused by?

Answer 10

abnormal exposure to estrogen

Question 11

What does precocious pseudopuberty result in?

Answer 11

development of secondary sexual characteristics without gametogenesis

Question 12

What is precocious pseudopuberty most often secondary to?

Answer 12

an ovarian tumor

Question 13

Define hydrocolpos.

Answer 13

collection of fluid, blood or pus within the vagina

Question 14

What is hydrocolpos or hydrometrocolpos usually secondary to in peds pts?

Answer 14

imperforate hymen

Question 15

When is hematocolpos frequently discovered? What is this associated with?

Answer 15

after menarche, when the collection of blood is trapped in the vagina or uterus leading to lower abd pain and mass

• primary amenorrhea

Question 16

Hydrocolpos accounts for ___% of abdominal masses in newborn females.

Answer 16

15%

Question 17

hemato = \_\_\_\_\_\_
pyo = \_\_\_\_\_\_
hydro = \_\_\_\_\_\_
metro = \_\_\_\_\_\_
colpos = \_\_\_\_\_\_

Answer 17

hemato = blood
pyo = pus
hydro = watery serous fluid
metro = uterus
colpos = vagina

Question 18

What is hydrometrocolpos? What is hematocolpos?

Answer 18

• fluid in uterus and vagina

- blood in the vagina

Question 19

Describe the sonographic findings of hydrocolpos.

Answer 19

• hypoechoic distention of vagina and/or endometrial cavity
• posterior acoustic enhancement
• internal echoes may be present and represent debris or clot
• hydronephrosis may be present in cases of severe obstruction