Pelvic Anatomy Flashcards
Compartmental Anatomy of the Female pelvis
- Anterior
- Middle
- Posterior
Anterior compartment:
- Urinary bladder, urethra
- Ureters
- Peritoneal recesses
- Fat planes
Middle compartment:
- Ovaries, fallopian tubes, uterus, vagina
- Broad ligament
- Meso-ovarium = double fold of peritoneum
Posterior comparment
- Rectum & surrounding connective tissues
- Peritoneal recesses
- recto uterine folds: uterosacral ligaments
- recto vaginal pouch (POD) - Fat planes
- rectovaginal septum
Other term of POD
Recto-vaginal pouch
Meaning of POD
Pouch of Douglas
Normal ovary of NEONATAL/INFANTS
Small follicles; may be >9mm
Seen in 84% of ovaries in infants <2 yrs
Normal ovary of CHILD (Pre-menarchal)
Small follicles; <9mm ; mean 6-7mm
Seen in 68% of ovaries in girls 2-12 yrs
Normal ovary of ADULT (Post-menarchal)
Increase in size ; descend deeper into the pelvis
Multiple follicles
Normal ovary of ADULT (Post-menopausal)
Decrease in size ; follicles disappear
Ovarian size best described by ovarian volume
0.523 x Width x Thickness x Length
Normal ovarian volume of NEONATAL/INFANT
1.0 cm3
Normal ovarian volume of PRE-PUBERTAL GIRLS (2-12 yrs)
0.7 to 4.0 cm3
Normal ovarian volume of POST-MENARCHAL
10 cm3 (2 x 3 x 4)
Main ovarian artery
Aorta
Dual blood supply:
- Aorta
- Adnexal branches of the uterine artery
Where the right ovarian vein drains into?
IVC
Where the left ovarian vein drains into?
Left renal vein
AP diameter of cervix prominent due to maternal hormones
Neonate
Decrease in size due to declining level of hormones
Child
Descends with adnexa deeper into pelvis; fundus elongates and thickens; pear-shaped uterus
Adult (post-menarchal)
Uterus atrophies such that uterine corpus is equal to or even smaller than cervix
Adult (post-menopausal)
3 layers of cervix
- Cervical mucosal layer
- Submucosal layer
- Cervical stromal layer
Inner layer of Cx
Cervical mucosal layer
Can be hypo-, iso- or slightly hyperechoic
Cervical mucosal layer
Thin hypoechoic layer
Submucosal layer (only sometimes seen)
Outer layer of the Cx
Cervical stromal layer
Usually of same echogenicity as myometriun
Cervical stromal layer
Normal mucosal folds of the cervical mucosa. They can invaginate deeply within the mucosa.
Plicae palmitae
Central echogenic band
Endometrium
Common benign uterine masses of Endometrium
- Polyp
- Endometrial hyperplasia
Common malignant uterine masses of Endometrium
- Endometrial carcinoma
- Endometrial stromal sarcoma
Common benign uterine masses of myometrium
- Leiomyoma
- Adenomyosis/adenomyoma
Common malignant uterine mass of myometrium
Leiomyosarcoma
Common benign uterine masses of endocervix?
- Polyp
- Leiomyoma
Common benign uterine mass of endocervix
Cervical carcinoma
Endometrial thickness of Menstrual Phase
4mm
Endometrial thickness of Proliferative Phase
5-12mm
Endometrial thickness of Secretory Phase
12-15mm
Endometrial thickness of Menopausal
4mm
Endometrial thickness of Patient on Tamoxifen/HRT
8mm
3 layers of endometrium
- Basal layer
- Functional layer
- Subendometrial layer
Trilaminar appearance
Late proliferative phase
The most appropriate first line imaging modality to asses the UT and ovaries in an adult
TV US
The appearance of the UT and ovaries depends on
- The stage of life cycle
- Phase of Menstrual Cycle
Solid appearing pattern with concave margins with no vascularity
Haemorrhagjc ovarian cyst
Fluid fluid level
Haemorrhagic cyst
“Fish-net” or reticular pattern within a cyst
Haemorrhagic cyst
XY karyotype; gonads fail to develop into testes in-utero and thus testosterone production
Swyer syndrome
Mullerian ducts develop into UT and fallopian tubes
Swyer syndrome
Normal UT length of NEONATE
3.5cm
b:c ratio of neonate
2:1
The appearance of endometrium is echogenic line with small amt of fluid
Neonate
Normal UT length of Paediatric
1-3cm
b:c ratio of paediatric
1:1
The appearance of endometrium is thin echogenic line
Paediatric
Appearance of UT is smaller and tubular in shape
Paediatric
Normal ut length of pre-pubertal/pubertal?
3-8cm
b:c ratio of pre-pubertal?
1.5 to 2:1
Normal ut length of reproductive?
8-9cm
b:c ratio of reproductive?
2:1
Normal ut length of post partum?
9-20cm
Endometrium thickness of menstrual phase
1-4mm
Endometrium thickness of proliferative phase (D5-13)
5-12mm
Endometrium thickness of secretory phase (D14-28)
12-15mm