Postmenopausal & Pediatric Pelvis Flashcards
Why scan a postmenopausal pelvis?
- abnormal bleeding
- palpable pelvic mass
- screen for cancer
Menses generally ceases between…
45-55 yrs old.
Postmenopausal bleeding may be due to normal…
atrophic endometrium.
The uterus becomes infantile with the most rapid decrease in the first…
5 yrs.
This is the most common gynecologic malignant disease after the age of 50.
endometrial cancer
The normal p.m. endometrium is…
atrophic, a thin echogenic line.
If the p.m. woman is not bleeding, the endometrial threshold is…
8 mm.
If the p.m. woman is bleeding, the endometrial threshold is…
4 mm.
If the p.m. woman is receiving HRT, the endometrial threshold may be up to…
8 mm.
HRT increases endometrial ___, endometrial ___, polyps and cancer.
thickness, hyperplasia
Why is HRT given?
To protect against fractures and alleviate menopause symptoms.
What kind of HRT is given to women with their uterus?
progesterone and estrogen
What kind of HRT is given to women who’ve had a hysterectomy?
just estrogen
Do not take HRT if:
- previous thromboembolic disease
- abnormal LFTs/liver disease
- breast cancer
- endometrial cancer
- fibroids
- endometriosis
In p.m. women who do not take estrogens, the endometrium is usually…
thin, atrophic, <4 mm
This drugs are used in adjunctive therapy in women who have breast cancer.
Tamoxifen and Megestrol Acetate
What side effect does Tamoxifen have?
thickened cystic endometrium, increased risk of endometrial carcinoma
Any bleeding more than ___ after the last mentstrual period is called ‘p.m. bleeding’.
six months
The two most common causes of pm bleeding are…
- exogenous estrogen administration
2. endometrial atrophy
In pm women an enlarged uterus is usually secondary to ___.
fibroids
Uterine enlargement is a late finding in ___.
endometrial cancer
___ is a late finding in endometrial cancer.
Uterine enlargement
Uterine calcifications are seen in women with ___ and in women with ___.
degenerated fibroids, arcuate artery calcification
These arteries run transversely in the myometrium.
uterine arcuate artery
These are visualized as either diffuse or focal thickening of the endometrium.
endometrial polyps
This diagnosis is suggested when the endometrium is thickened with a heterogeneous echotexture and ill-defined margins between the endometrium and the myometrium.
endometrial cancer
Demonstration of myometrial invasion is clear evidence of…
endometrial cancer.
Patients with advanced endometrial cancer have ___ of the uterus, a ___ uterine contour, and mixed ___ of the myometrium.
enlargement, lobular, echogenicity
Name four sonographic abnormalities of the p.m. uterus.
- enlargement
- calcifications
- polyps
- endometrial cancer
Name two reasons to see calcifications in the uterus.
- degenerating fibroids
2. calcified arcuate arteries
Name two defining aspects of an endometrial polyp.
- has a vascular stalk
2. is best seen with sonohysterography
An ovary that is ___ should be regarded with suspicion.
twice the size of the contralateral ovary
The incidence of ovarian cancer increases as…
the age of the patient increases.
Bilateral solid adnexal masses are probably…
- fibromas
- ovarain cancer
- metastatic disease
Hydrosalpinx and pyosalpinx occur ___ in p.m. women.
infrequently
T/F? Hydrosalpinx is often painful and related to prior PID.
FALSE, asymptomatic
TOA stands for…
tubo-ovarian abscess
T/F? TOAs are most common in patients with recent D&C and malignant disease.
true
A vaginal cuff is ___ in woman with recurrent disease.
enlarged
Small amounts of ___ are occasionally seen in the cul-de-sac of asymptomatic pm women.
free fluid
A large amount of ___ in the cul-de-sac in a pm woman is associated with various disease processes including malignant tumors.
free fluid
In the newborn female, the cervix is ___ compared to the corpus.
twice as long
T/F? In the newborn female, the endometrium is brightly echogenic.
true
In the two month old female, the cervix is ___ compared to the corpus.
equal (2.5-3.5 cm)
The pediatric uterus maintains infantile appearance until around age
5-6 yrs.
T/F? Pediatric ovaries are not cystic.
FALSE, they’re usually less than 9 mm.
At puberty, the uterus gradually increases in length to…
5-7 cm.
At puberty, the cervix is ___ compared to the corpus.
three times smaller
You might do an exam on a pediatric patient to rule out ovarians complications including…
suspected PCOS and ovarian neoplasms.
You might do an exam on a pediatric patient to rule out uterine complications including…
uterine anomalies and ambiguous genitalia.
This results from an early but normal pattern of gonadotropin secretion from the pituitary.
precocious puberty
This results in the development of the secondary sexual characteristics before the age of 8 years old.
precocious puberty
Precocious puberty happens before the age of…
8 yr old.
Precocious puberty is caused by abnormal exposure to estrogen, most typically via
ovarian tumor, like a granulosa theca cell tumor.
This is fluid in the uterus and vagina.
hydrometrocolpos
This is blood in the uterus and vagina.
hematometrocolpos
Lower abdominal mass in a newborn female? Might be…
hydrocolpos.
Sonographically, hydrocolpos appears as a ___echoic distention of the vagina and endometrial cavity, with ___, internal ___, and possibly hydro___.
hypo-, posterior acoustic enhancement, echoes, -nephrosis
This is a generic term for a collection of fluid, blood, or pus in the vaginal or uterine cavity.
hydrocolpos
This is a thin membrane that completely covers the opening to a young girl’s vagina.
imperforate hymen
