Pelvic (uterine and endometrial abnormalities) Flashcards
Indications for a Pelvic US for Endometrium
- irregular bleeding
- heavy bleeding
- spotting
What could be a cause of abnormal bleeding that is not from the myometrium or endometrium?
-submucosal fibroid
Causes of Endometrial Thickening
- pregnancy
- retained products of conception
- fibroids (submucosal or intracavitary)
- endometritis
- adhesions
- hyperplasia
- polyps
- carcinoma
When can endometritis (inflammation of endometrium) occur?
- postpartum
- after D & C
- associated with PID
Endometrium Appearance with Endometritis
- thick
- irregular
- possible fluid
- gas with acoustic shadowing
Common Causes of Abnormal Bleeding from Endometrium
- hyperplasia
- polyps
- endometrial carcinoma (rare endometrial sarcoma)
- atrophy
**all can have a similar sono appearance
Endometrial Hyperplasia
- increase in # of cells
- over growth of endometrial glands (irregular size and shape)
2 Common Types of Endometrial Hyperplasia
- hyperplasia
- cystic hyperplasia
What is the most common reason for hyperplasia?
-unopposed estrogen stimulation in peri/postmenopausal women
Hyperplasia in Reproductive Years
- less common
- anovulatory cycles
- polycystic ovarian disease
- obese women (increase in estrogen)
- estrogen producing tumors
Sono Appearance of Hyperplasia
- thick
- echogenic
- well defined endo
- cystic areas
Differential Diagnosis of Hyperplasia
- diffuse polyps
- endo carcinoma
- endometrial atrophy that is displaying cystic components (looks thick)
Endometrial Polyps
- benign
- growth projecting into cavity
- pedunculated or broad based
- common
- increase in peri/postmenopausal women
- mostly asymptomatic or bleeding
- single/multiple
Sono Appearance of Endometrial Polyps
- echogenic focal area within endo
- endometrial thickening
- if it has the same echogenicity as endometrium, it is probably a polyp
Differential Diagnosis for Polyps
- hyperplasia
- endometrial cancer
- submucosal fibroid
What is colour doppler helpful with when imaging polyps?
- vascular stalk (pedicle artery sign)
- do not need SGH (sonohystogram/saline infusion) if seen with regular US
Sonohysterography (endometrium saline infusion)
- good at differentiating polyp vs fibroid
- polyp seen arising from endo
- submucosal fibroid normal layer endo is seen overlying
Treatment of Polyps
- D & C on woman with polyps (PMB)
- polyps can be missed with D & C
- hysterectoscopy recommended if still bleeding and endo >8mm
Endometrial Carcinoma
- highly curable
- 75% confined to uterus at clinical presentation
What is the most common gynecologic malignancy in North America?
-endometrial carcinoma
Who does endometrial carcinoma most commonly occur in?
-postmenopausal women (75-80%)
What is the most common clinical presentation of endometrial carcinoma?
-uterine bleeding
What % of women with PMB have endometrial cancer?
10%
Endometrial Cancer on US
- thickening endo is considered cancer until proven otherwise
- heterogenous echotexture
- irregular/poorly defined margina
- obstruction can block cervix (hydrometer or hematometra)
