Practise viva Flashcards
Hydrops
At least 2 fetal oedema components
Immune (blood group incompatibility) or non-immune
Non-immune: Turners or trisomy, cardiac disease, infection, twin related, neoplastic (AV shunts), inborn errors of metabolism, anaemia,
Immune now uncommon due to practice of giving mother anti-immunoglobulin when she is Rhesus negative
Endometrial thickening
Best measured immediately post-menstrual / early proliferative
Hyperplasia, neoplasia / carcinoma, polyp, tamoxifen (causes polyps, hyperplasia, carcinoma), infection
15mm top normal for secretory. <6mm to exclude thickening. Should not be above 5 post menopause
Cornual ectopic / other ectopics
Cornual sometimes used interchangeably with interstitial ectopic, but should be reserved for when there is a rudimentary horn (bicornuate or septate)
Interstitial ectopics have a higher risk of rupture and haemorrhage compared with tubal ectopics. Present later with larger size.
Risk factors for ectopic: Prior IVF Tubal surgery or inflammation PID Salpingitis isthmica nodosa (nodular scarring of tubes, controversial aetiology, not post infective) IUDs Congenital abnormalities
HCG tends to rise at a slower rate
At <2000 may not see an intrauterine pregnancy anyway
Heterotopic essentially only occurs in IVF
Symmetric v asymmetric growth restriction
Symmetric - all measurements <10%
A - classically AC <10%
S: Trisomy, infection, maternal drugs
A: Placental insufficiency. Low or minimal karyotype abnormalities. HC reduced in maternal cocaine
Uterine artery assessment
High resistance non-pregnant waveform, drops in resistance during pregnancy. Abnormally high resistance increases risk of pre-eclampsia and IUGR
Notching (trough like between systole and diastole) should not persist throughout pregnancy (22 weeks). Bilateral more concerning, or unilateral on same side as unilateral placenta
Normal RI <0.5
Umbilical artery assessment
Surveillance of fetal wellbeing in 3rd trimester
Should be low resistance, PI approximately 1
Normal???
CPR should be greater than one (MCA should be high resistance)
Filling defects on HSG
Fibroids, polyps, cancer, adhesions
Ashermans / uterine synechiae is multiple adhesions, associated with infertility, often develops after pregnancy
Breast density
Fatty
Scattered fibroglandular
Heterogeneously dense
Dense
Technically adequate mammogram
Nipple in profile, and midline on CC
Pectoral shadow down to nipple level or lower
Inframammary fold seen
Symmetric
Posterior nipple line similar, within 1cm, on CC and MLO
Gynaecomastia
Usually unilateral / asymmetric
Flame shaped (mammography) Disc shaped (palpation, ultrasound - hypoechoic, triangular)
CODES Cirrhosis Obesity Digitalis Estrogen (or androgen deficiency - the imbalance) Spirinolactone
Testicular tumours - examine testes.
Estrogenic tumours may also cause (adrenal, liver, lung, pituitary)
Senescent change - pseudogynaecomastia - increased fat and decreased muscle. No actual mass
Ovarian torsion
Mostly dermoids or paraovarian cysts
Hyperstimulated cystic ovaries at high risk
Enlarged ovary, midline, peripheral follicles, with altered vascularity
ASUM fetal demise
MSD > 25mm no HB FP >7mm no HB Both > or = 14 days after GS seen no HB 11 days after GS with yolk sac no HB
Uterine congenital abnormalities
Septate most common
Septum can be removed.
Normal external contour, unlike bicornuate
Arcuate is mild indentation at fundus
Didelphys there are two cervixes, vaginas
Can have two cervixes in bicornuate
Cleopatra view
Axillary view
An exaggerated CC for if can only see on MLO in axilla
Placental abruption
Associated with smoking, cocaine, PROM, thrombophilia, chorioamnionitis, previous abruption
Retroplacental haematoma not commonly seen. Hyperechoic actutely then becomes hypo
Small treated conservatively. Risk of IUGR or demise.
Subchorionic haemorrhage - increased risk of preterm labour and of placental abruption
Molar pregnancy
Complete mole Diploid XX, or less commonly XY - All chromosomes from sperm - snowstorm, bunch of grapes, bilateral theca lutein cysts
Partial mole triploid usually XXY (can be XXX or XYY)
Complete may progress to invasive mole, or choriocarcinoma
Major cardiac views on fetal ultrasound
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Bilateral ovarian tumours
Serous tumours are more commonly bilateral than mucinous. Serous are more common. Mucinous oftern larger, multiseptated. Serous tumours more commonly calcify Most likely mets
Krukenberg tumour is adenocarcinoma met to ovary.
Stomach, colon most common
Breast and lung next most common mets, and oppositve ovary
Inflammatory breast cancer
Clinical appearance of breast swelling and skin thickening. Mimics mastitis
Can be any type of invasive carcinoma, but most commonly ductal
Tendency to early metastasis
Poor prognosis
Dilated dermal lymphatics in 80%. Invasion of these pathognomonic
BIRADS 5
Highly likely to be malignant
Any 2 of - spiculated or irregular mass
High density
Fine linear or linear branching segmental calcifications
BIRADS 2
Lymph nodes
Cysts
Calcified fibroadenomas
Fat containing lesions - hamartomas, oil cysts, lipomas, galactoceles
Ductus venosus
Most sensitive to cardiac function
S, D, and A waves
Cervical funnelling
Percentage (funnel length / functional cervix + funnel)
Shape (U shaped higher risk of preterm delivery than V shaped)
Cervical length should be at least 30mm
Normal mammary ducts
Up to 3mm on ultrasound
Lobular carcinoma
Often difficult to see as don’t invoke desmoplasia
Still stellate mass is the most common presentation
Often bilateral
Leptomeningeal spread more common
Calc rare
52% sensitivity of mammography
Less than 30% well defined
DCIS
10% present as mass
10% present as mass with calcs
80% just calcs - pleomorphic, amorphous
Breast implants
Saline or silicone
Fibrous capsule forms around implant, which may calcify
May have herniation through capsule without rupture of implant
May have intra or extra capsular implant rupture
Linguine sign is of intracapsular implant rupture (silicone)
Silicone implants should have uniform density and no valve
Silicon will be denser peripherally, and have a valve
Snowstorm appearance of extracapsular silicone rupture on ultrasound
Single deepest pocket
2-8cm normal
True lateral
Calcs - tea cupping
Masses - localisation
And for biopsy planning
Placenta praevia
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Uterus didelphus
With haemotcolpos?
Breast conserving surgery
Must be <40mm
Molar pregnancy
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Placental abruption
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Fetal echo views
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Endometrial cancer
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SROM
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Krukenberg tumour
Metastatic tumour to ovary
Mucinous signet ring cells, most commonly from GI tract
Stomach > colon
May also be breast, lung, contralateral ovary, pancreatic, cholangio, gallbladder
Keyhole bladder
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Fetal demise
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Mucinous v serous ovarian tumour
Serous more common
Serous more commonly unilocular
Mucinous multiple thin septa
Serous more commonly bilateral - 15%
Ovarian teratoma
CT:
Fat fluid level
Rokitansky nodule or dermoid plug (calicum, hair, teeth, sebaceus, fat)
Suspect malignant transformation if large (>10cm) or irregular soft tissue borders
USS:
Dot dash and tip of the iceberg
Monitor if large. May surgically remove
Risk of torsion
Anti NMDA limbic encephalitis
Posterior urethral valves
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Renal dilatation
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Renal cystic disease
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Polyhydramnios
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Oligohydramnios
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Omphalocele
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Trisomy 18
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Written case with enlarged cisterna magna, omphalocele, AV canal defect, curved fingers / hands
Look these images up and review them - was in the writtens
Choroid plexus cysts Mega cisterna magna Associated with spina bifida, talipes, Rocker bottom feet Clenched hands Radial ray Single umbilical artery Horseshoe kidney
Trisomy 13
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Trisomy 21
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Turners
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Meigs syndrome
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Fibroma / thecoma?
This was in the writtens - review the images
Endometriosis
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Lemon sign
Concavity of frontal bones, as part of Chiari 2
Fetal ventriculomegaly
> 10mm. Mild to 12, Moderate to 15, severe above 15
Separation of choroid plexus >3mm (dangling choroid)
Mild is a soft marker for chromosomal abnormality
Aqueduct stenosis Chiari Neural tube defect Dandy Walker Holoprosencephay Obstructing mass Other
Obstructive, dysgenesis, or destructive
Choroid plexus cysts
In up to 50% of Tri 18
Also 21, Klinefelter
Mega cisterna magna
Infarction
Infection esp CMV
Trisomy 18
> 10mm
Single umbilical artery
Increased incidence in twins and diabetes
Increased incidence of IUGR
Chromosomal abnormality (21, 18, 13 in that order) - soft sign Persistent left umbilical vein Renal anomalies - agenesis on same side Sirenomelia (mermaid) Velamentous cord insertion
Clubfoot
Large number of associations:
Choromosomal: trisomy 18, 18q deletion
Renal: prune belly and agenesis
Connective tissue: marfans, ehlers danlos
Spinal anomalies: caudal regression, diastrmatomyelia, spina bifida
Rockerbottom foot
13, 18, 18q deletion
Spina bifida, arthrogryposis (which itself may be syndromic or non-syndromic)
Echogenic bowel
Soft marker for trisomy 21
Also seen in CF, CMV, demise, IUGR, amniotic haemorrhage
Echogenic cardiac focus
Soft marker
Trisomy 21, and 13
Dual chamber higher risk
Soft signs
Echogenic intracardiac focus (21>13) Ventriculomegaly Nuchal fold >6mm (turners,21) Echogenic bowel (21,CMV,CF,demise) Hypoplastic or absent nasal bone (21, rarely fetal warfarin syndrome) Shortened long bones Renal pyelectasis (21) Choroid plexus cysts (18>21,Klinefelter) Aberrant right subclavian artery (21,18) Single umbilical artery (21>18>13) Mega cisterna magna (18,CMV, infarction) Rocker bottom feet (13,18,18qdeletion) Clenched fists (18>13) Sandal gap (21) Strawberry skull (18)
Sandal gap deformity
Downs
Strawberry skull
Aneuploidy, particularly 18
Cloverleaf skull, strawberry skull, lemon skull
Lemon - Chiari 2 - concave frontals
Strawberry - Tri 18. Flattened occiput, pointed frontal bones with hypoplastic frontal lobes, brachycephaly
Cloverleaf - severe multiple craniosynostosis - thanatophoric dysplasia, Aperts, Crouzon
Breast calc biopsy
Need >5 in one specimen, or calc in 3 samples
Lymph node thickness, axilla
Normal cortex <3mm
Fibroadenoma
Popcorn calc
Hypoechoic, well circumscribed, macrolobulated mass
Associated with cyclosporin use, and Cowden syndrome(AD, GI hamartomas, mucocutaneous lesions, breast disease, increased risk of breast Ca, follicular thyroid ca, Lhermette Duclos)
?Consider excision if >30mm
Fetal pericardial effusion
> 2mm
Associated with hydrops, aneuploidy, cardiac anomalies
Breast lesion benign ultrasound features
Well circumscribed hyperechoic (fat containing lesion - lipoma, hamartoma)
Wider than deep
Gentle macrolobulation
Thin echogenic pseudocapsule (in a wider than deep lesion) (represents normal compressed tissue so therefore not an infiltrative disease)
Malignant breast ultraound features
Taller than wide Spiculated Microlobulated Thick hyperechoic halo Annular margins Markedly hypoechoic Acoustic shadowing Branching pattern Punctate calcs Duct extension
