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Term 2 > Pelvic (uterine and endometrial abnormalities) > Flashcards

Pelvic (uterine and endometrial abnormalities) Flashcards

1
Q

Indications for a Pelvic US for Endometrium

A
  • irregular bleeding
  • heavy bleeding
  • spotting
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2
Q

What could be a cause of abnormal bleeding that is not from the myometrium or endometrium?

A

-submucosal fibroid

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3
Q

Causes of Endometrial Thickening

A
  • pregnancy
  • retained products of conception
  • fibroids (submucosal or intracavitary)
  • endometritis
  • adhesions
  • hyperplasia
  • polyps
  • carcinoma
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4
Q

When can endometritis (inflammation of endometrium) occur?

A
  • postpartum
  • after D & C
  • associated with PID
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5
Q

Endometrium Appearance with Endometritis

A
  • thick
  • irregular
  • possible fluid
  • gas with acoustic shadowing
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6
Q

Common Causes of Abnormal Bleeding from Endometrium

A
  • hyperplasia
  • polyps
  • endometrial carcinoma (rare endometrial sarcoma)
  • atrophy

**all can have a similar sono appearance

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7
Q

Endometrial Hyperplasia

A
  • increase in # of cells

- over growth of endometrial glands (irregular size and shape)

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8
Q

2 Common Types of Endometrial Hyperplasia

A
  • hyperplasia

- cystic hyperplasia

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9
Q

What is the most common reason for hyperplasia?

A

-unopposed estrogen stimulation in peri/postmenopausal women

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10
Q

Hyperplasia in Reproductive Years

A
  • less common
  • anovulatory cycles
  • polycystic ovarian disease
  • obese women (increase in estrogen)
  • estrogen producing tumors
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11
Q

Sono Appearance of Hyperplasia

A
  • thick
  • echogenic
  • well defined endo
  • cystic areas
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12
Q

Differential Diagnosis of Hyperplasia

A
  • diffuse polyps
  • endo carcinoma
  • endometrial atrophy that is displaying cystic components (looks thick)
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13
Q

Endometrial Polyps

A
  • benign
  • growth projecting into cavity
  • pedunculated or broad based
  • common
  • increase in peri/postmenopausal women
  • mostly asymptomatic or bleeding
  • single/multiple
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14
Q

Sono Appearance of Endometrial Polyps

A
  • echogenic focal area within endo
  • endometrial thickening
  • if it has the same echogenicity as endometrium, it is probably a polyp
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15
Q

Differential Diagnosis for Polyps

A
  • hyperplasia
  • endometrial cancer
  • submucosal fibroid
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16
Q

What is colour doppler helpful with when imaging polyps?

A
  • vascular stalk (pedicle artery sign)

- do not need SGH (sonohystogram/saline infusion) if seen with regular US

17
Q

Sonohysterography (endometrium saline infusion)

A
  • good at differentiating polyp vs fibroid
  • polyp seen arising from endo
  • submucosal fibroid normal layer endo is seen overlying
18
Q

Treatment of Polyps

A
  • D & C on woman with polyps (PMB)
  • polyps can be missed with D & C
  • hysterectoscopy recommended if still bleeding and endo >8mm
19
Q

Endometrial Carcinoma

A
  • highly curable

- 75% confined to uterus at clinical presentation

20
Q

What is the most common gynecologic malignancy in North America?

A

-endometrial carcinoma

21
Q

Who does endometrial carcinoma most commonly occur in?

A

-postmenopausal women (75-80%)

22
Q

What is the most common clinical presentation of endometrial carcinoma?

A

-uterine bleeding

23
Q

What % of women with PMB have endometrial cancer?

A

10%

24
Q

Endometrial Cancer on US

A
  • thickening endo is considered cancer until proven otherwise
  • heterogenous echotexture
  • irregular/poorly defined margina
  • obstruction can block cervix (hydrometer or hematometra)
25
Q

Endometrial Carcinoma on US

A
  • well defined
  • uniformly echogenic
  • can have the same appearance as endo hyperplasia or polyps
26
Q

What are some possible differential diagnosis of thickened endo in peri/postmenopausal years?

A
  • hyperplasia
  • polyps
  • cancer
  • *need biopsy for definitive diagnosis
27
Q

Role of Colour and Spectral Doppler

A
  • 1st thought low resistance flow in uterine arteries distinguished normal postmenopausal endo from cancer
  • found not significant
  • endometrial thickness is better method
28
Q

Role of Sonography Pre-Op Endo CA

A
  • determine myometrial invasion

- intact subendometrial halo (inne layer of myometrium)

29
Q

MRI for Staging and Pre-Op

A
  • contrast enhanced MRI superior method
  • myometrial invasion
  • cervical extension
  • extrauterine extension
30
Q

Uterine Sarcomas

A
  • rare

- leiomyosarcomas

31
Q

Where do uterine sarcomas arise from?

A
  • carcinosarcomas
  • endometrial stromal sarcomas
  • adenosarcomas
  • undifferentiated sarcomas
32
Q

Endo Stromal

A
  • diffuse or focal
  • may involve myometrium
  • mistaken for leiomyoma
33
Q

Endometrial Atrophy on US

A
  • thin (<5mm)

- homogenous

34
Q

Causes of Metrorrhagia

A
  • pregnancy
  • systemic disease
  • endo polyps or hyperplasia
  • endo cancer
  • IUD malposition
  • cesarean section scar defect

Term 2 (19 decks)

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