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Term 2 > Pelvic (congenital abnormalities of uterus) > Flashcards

Pelvic (congenital abnormalities of uterus) Flashcards

1
Q

What are the 3 congenital anomalies of the uterus?

A

1) arrested development
2) failure of fusion
3) failure of resorption

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2
Q

Arrested Development

A

Bilateral:

  • rare
  • uterus nails to develop or hypo plastic

Unicornuate Unicollis:

  • sm uterus
  • 1 horn, 1 cervix
  • associated with renal congenital anomalies
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3
Q

Failure of Fusion

A

-mullarian ducts fail to fuse

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4
Q

Results of Failure of Fusion

A
  • bicornuate unicollis
  • bicornuate bicollis
  • didelphys
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5
Q

Bicornuate Bicollis

A
  • 1 uterus
  • difficult to distinguish from didelphys
  • more common than didelphys
  • failure of fusion happens more superior
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6
Q

Didelphys

A
  • 2 cervix’s
  • 2 uterus’
  • sometimes 2 vagina’s
  • rare
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7
Q

What happens if you become pregnant with a bicornuate bicollis?

A
  • growth restrictions
  • preterm delivery
  • C section
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8
Q

What is the difference between unicollis and bicollis?

A

-where failure of fusion occurs

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9
Q

Can you become pregnant with didelphys?

A
  • yes

- may have fertility issues

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10
Q

Failure of Resorption

A
  • medium septum does not get resorbed
  • normal exterior uterine contour
  • sepate or subseptate
  • arcuate (slight dip)
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11
Q

What is failure of resorption associated with?

A
  • spontaneous abortions (can’t stay pregnant)

- fertility issues

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12
Q

What is the most common mullein duct anomaly?

A

-septate uterus

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13
Q

How do you know if there is an anomaly with 2D US?

A
  • should see endometrium dividing in TRV
  • how far apart are the endometrium
  • contour
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14
Q

What is important with failure of fusion?

A

-plan for early delivery

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15
Q

What could be a reason for multiple miscarriages?

A

-failure of resorption

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16
Q

When is the best time in a women”s menstrual cycle to scan for uterine congenital anomaly?

A

-secretory

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17
Q

Diethylstilbestrol

A
  • drug taken by mother (difficult pregnancy)
  • ended in 1971
  • given in 1st trimester
  • irregular T shapes uterine cavity
  • small
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18
Q

Uterine Abnormalities

A
  • leiomyoma (fibroids)
  • lipomatous uterine tumors
  • leiomyosarcoma
  • adenomyosis
  • arteriovenous malformations (AVM)
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19
Q

Fibroid/Leiomyoma

A
  • benign solid uterine tumor
  • composed of smooth muscle cells and fibrous
  • usually multipleCT
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20
Q

What is the most common neoplasm (tumor) of the uterus?

A

-leiomyoma/fibroids

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21
Q

Who is leiomyoma/fibroid’s common in?

A
  • 20 to 30% of women > 30 years old

- more common in black women

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22
Q

What is the most common cause of enlargement of non pregnant uterus?

A

-leiomyoma/fibroid

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23
Q

What are leiomyoma’s/fibroid’s dependant on?

A

-estrogen (decrease in side in menopause)

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24
Q

Symptoms of Leiomyoma’s/Fibroid’s

A
  • often asymptomatic
  • pain
  • bleeding
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25
Q

Fibroid Classification

A
  • intramural
  • submucosal
  • subserosal
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26
Q

Intramural Fibroid

A
  • most common

- in myometrium

27
Q

Submuscosal Fibroid

A
  • less common
  • projecting into uterine cavity (displacing endometrium)
  • infertility
28
Q

Subserosal Fibroid

A
  • projects out from myometrium

- distorts contour of uterus

29
Q

Pitfalls of Pedunculated Subserosal Fibroids

A
  • seen or confused with adnexal mass

- can project between broad ligament (intraligamentour)

30
Q

Cervical Fibroids

A
  • classified based on cervix location
  • 8% are located in cervix
  • includes intramural, submuscosal and subserosal
31
Q

Sonographic Appearance of Fibroids

A
  • hypoechoic
  • heterogenous
  • areas of attenuation
  • distorted contour
32
Q

US Role with Fibroids

A
  • location
  • size
  • single or multiple
  • origin
  • attachement to uterus
33
Q

Postmenopausal Fibroids

A
  • rare
  • decrease/stabilize in size
  • calcified
  • can increase in size if on HRT or tamoxifen
34
Q

When might fibroids increase in size?

A

-pregnancy

35
Q

Vascularity of Fibroids

A
  • peripheral

- uterine vessels supplying fibroids

36
Q

Fibroids Transabdominal

A
  • larger FOV
  • better assessing of lg fibroids
  • can be missed of TVP
37
Q

Fibroids TVP

A
  • good at detecting fibroids
  • origin of lg pedunculate, subserodal fibroids vs. adnexal mass
  • fundal fibroids on retroverted uterus
38
Q

Treatment of Symptomatic Fibroids

A
  • uterine artery embolization (UAE)
  • surgical treatment (hysterectomy)
  • medical treatment
39
Q

Lipomatous Uterine Tumors/Lipoleimyomas

A
  • uncommon
  • benign
  • consists of mature lipocytes, smooth muscle, fibrous tissue
40
Q

Lipomatous Uterine Tumors/Lipoleimyomas on US

A
  • echogenic, attenuating mass
  • in myometrium
  • no colour
  • asymptomatic
41
Q

Leiomyosarcoma

A
  • rare
  • malignant
  • may arise from leiomyoma
  • asymptomatic or uterine bleeding
  • same symptoms as fibroid
42
Q

What % of uterine cancers are leiomyosarcoma?

A

1.3%

43
Q

Leiomyosarcoma on US

A
  • rapid growth or degenerating fibroid
  • rarely diagnosed preoperatively
  • exception (may see local invasion of bladder or rectum)
  • distant mets
44
Q

What is a clue for leiomyosarcoma?

A
  • rapid growth

- post menopausal growth

45
Q

Adenomyosis

A
  • common
  • endometrial glands and stroma within myometrium
  • associated with sooth muscle hyperplasia
  • diffuse or nodular
  • fibroids may be possible
46
Q

Diffuse Adenomyosis

A
  • common

- widely scattered foci in myometrium

47
Q

Nodular Adenomyosis

A

-circumscribed nodules

48
Q

Clinical Presentation of Adenomyosis

A
  • nonspecific
  • uterine enlargement
  • pelvic pain
  • dysmenorrhea
  • common in women with children
49
Q

How are adenomyosis seen best?

A

-TVP

50
Q

Adenomyosis on US

A
  • enlarged
  • heterogenous
  • asymmetrical thickening of myometrium
  • inhomogenous hypoechoic areas
  • myometrial cysts
  • poor delineation of the border between endo and myo
  • focal tenderness with TVP
  • subendometrial echogenic linear striations
  • subendometrial echogenic nodules
51
Q

Localized Adenomyosis

A
  • can be confused with fibroid
  • inhomogenous, circumscribed area within myometrium
  • ill defined borders
  • internal vascularity
52
Q

Lieomyomas

A
  • well defined borders

- peripheral vascularity

53
Q

What imaging modalities are good at diagnosing adenomyosis?

A
  • MRI

- US

54
Q

Arteriovenous Malformations (AVM)

A
  • vascular plexus of arteries and veins with no capillary network
  • rare lesion
55
Q

How are most AVM’s acquired?

A
  • pelvic trauma
  • surgery
  • gestational trophoblastic neoplasia
56
Q

How are AVM’s diagnosed?

A
  • postabortion and postpartum periods
  • severe vaginal bleeding
  • D & C (could worsen bleeding or hemorrhage)
57
Q

AVM’s on 2D US

A
  • multiple, tortuous, anechoic structures
  • myometrium is heterogenous
  • myometrial or endometrial mass
58
Q

AMV’s on Colour Doppler

A
  • better
  • increase colour flow shown
  • coloured mosaic pattern
59
Q

AMV’s on Spectral Doppler

A
  • high velocity
  • low resistance arterial flow
  • high velocity venous flow (more like an artery)
60
Q

Differential Diagnosis of AVM’s

A
  • retained products of conception (RPOC)
  • GTN (gestational trophoblastic neoplasia)
  • subinvolution of placental bed
  • neg. hCG can help distinguish
61
Q

Treatment of AVM’s

A
  • may resolve

- emboization if severe bleeding

62
Q

Monckeberg’s Arteriosclerosis

A
  • form of arteriosclerosis (hardening/calcifications of vessels)
  • calcium deposits around muscular middle layer of artery walls (tunica media)
  • in peripheral, coronary arteries and genital organ arteries
63
Q

Cause of Monckeberg’s Arterioclerosis

A
  • unknown cause
  • no S/S
  • increasing age
64
Q

What is Monckeberg’s Arteriosclerosis associated with?

A
  • diabetes
  • chronic kidney disease
  • lupus
  • chronic inflammatory conditions

Term 2 (19 decks)

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