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Pelvic > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

what are the types of tumors?

A
  • surface epithelial-stroma
  • germ cell
  • sex cord-stromal
  • metastatic
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2
Q

what is the most common of all ovarian tumour groups?

A

Serous Cystadenoma / Serous cystadenocarcioma

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3
Q

describe Serous Cystadenoma / Serous cystadenocarciomas

A
  • big ovarian tumors
  • malignant version usually affects peri and post menopausal women
  • looks similar to mucinous-usually more anechoic
  • not good prognosis if malignant due to late detection
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4
Q

describe Mucinous cystadenoma/cystadenocarinoma

A

largest of all tumors

  • 30cm taking up all pelvis
  • thick mucous within sonographically debris within
  • very similar to serous variety
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5
Q

what is largest of all tumors?

A

Mucinous cystadenoma/cystadenocarinoma

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6
Q

slide 8 lesson 9

A

doesn’t make sense

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7
Q

Transitional cell aka Brenner Tumour appearance

A

can look like a hypoechoic mass (thick fibroid)

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8
Q

what are differentials for Transitional cell aka Brenner Tumour?

A

tumors in sex-chord stromal group

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9
Q

what are borderline tumors for Transitional cell aka Brenner Tumour?

A

can look similar to serous and mucinous

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10
Q

where do the germ cell tumors originate?

A

endoderm
mesoderm
ectoderm

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11
Q

what is the most common and benign Represent 95% of all the tumours in the Germ cell category?

A

dermoid or cystic teratoma

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12
Q

what are dermoid filled with?

A

hair
teeth
fat

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13
Q

why may dermoids have a different sonographic appearance?

A

based on the tissue growing within the tumor

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14
Q

what is the significance of knowing the dermoid?

A

easily missed if not looking due to attenuation “tip of the iceburg” might think its bowel

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15
Q

what are some names of appearances of a dermoid?

A
  • dermoid plug
  • tip of the iceberg
  • dermoid mesh
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16
Q

what are some other rare germ cell tumors?

A
  • yolk sac

- immature teratoma

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17
Q

yolk sac tumor

A
  • malignant
  • young age
  • fatal
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18
Q

immature teratoma

A

look similar to dermoid start to have malignant features

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19
Q

what are sex chord-stromal tumors formed from?

A

sex chord cells

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20
Q

what does sex chord stromal tumors cause?

A
  • produce estrogen (granulosa and thecoma)

- cause viralization (male traits)

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21
Q

are sex-chord stromal tumours rare or common?

A

rare

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22
Q

who does sex chord stromal tumours tend to affect?

A

younger women and girls

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23
Q

what looks like fibroids with sex chord-stromal tumours?

A

fibroma and thecoma

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24
Q

what is sex cord-stromal tumours associated with?

A

meig’s syndrome

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25
Q

what is meig’s syndrome?

A

the presence of ascites and pleural effusion in association with a benign, usually solid ovarian tumour
(ovarian fibroma or fibroma-like tumor)

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26
Q

what is the etiology of meig’s syndrome?

A

The cause of Meigs’ syndrome does not appear to be clear although there seems to be an inflammatory reaction that causes the ascites and pleural fluid accumulation.

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27
Q

what are the signs and symptoms of meig’s syndrome?

A 
Fatigue
Shortness of breath
Increased abdominal girth
Weight gain/weight loss
Bloating
Amenorrhea 
Menstrual irregularity
Benign ovarian tumor
Ascites 
Pleural effusion
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28
Q

what is the sonographic appearance of meig’s syndrome?

A
  • tumor arising from the pelvis
  • fullness of flanks
  • ovarian mass
  • hypoechoic mass with marked posterior attenuation
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29
Q

differential diagnosis of meigs syndrome?

A 
Cirrhosis
Colon Cancer, Adenocarcinoma
Hypoalbuminemia
Lung Cancer
Milroy Disease
Nephrotic Syndrome
Ovarian Cancer
Tuberculosis
pedunculated fibroid or Brenner's Tumor
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30
Q

what are the outcomes of meig’s syndrome?

A
  • bengin and the ascites and pleural effusion resolves after resection of the primary pelvic tumour
  • drain off the excess fluid for symptomatic relief
  • unilateral salpingo-oophorectomy or wedge resection is the treatment of choice
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31
Q

are metastatic ovarian tumours benign or malignant?

A

malignant

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32
Q

where do metastatic ovarian tumours come from?

A
  • colon or gastric
  • breast
  • lymphoma
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33
Q

metastatic ovarian tumours are not a good _____________

A

prognosis

-already have primary now spread

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34
Q

krukenburg tumour

A

metastatic ovarian tumor that originates from the stomach/colon cancer

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35
Q

are metastatic tumors unilateral or bilateral?

A

bilateral

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36
Q

sonographic appearance of bengin

A
  • well defined anechoic lesions

- thin septations

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37
Q

sonographic appearance of malignant

A
  • irregular walls
  • thick irregular septations
  • mural nodules
  • solid echogenic element
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38
Q

what should doppler findings be combined with?

A
  • morphological
  • clinical findings
  • patient age
  • phase of menstrual cycle
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39
Q

colour and pulsed wave doppler benign

A
  • more peripheral flow

- higher resistive flow

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40
Q

colour and pulsed wave doppler malignant

A
  • tend to have more centralized flow
  • lower PI
  • Lower RI
  • higher diastolic flow
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41
Q

what is one of the leading causes of maternal deaths in the US?

A

ectopic pregnancy

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42
Q

what is an ectopic pregnancy?

A

pregnancy not implanted within the endometrium

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43
Q

what is the classic triad for clinical presentation for ectopic pregnancy?

A
  • pain
  • abnormal vaginal bleeding
  • palpable adnexal mass
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44
Q

what are some further clinical presentations of ectopic pregnancy?

A

Pain
Abnormal vaginal bleeding
Palpable adnexal mass

Amenorrhea
Adnexal tenderness
Cervical excitation pain

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45
Q

what are some pathologies with similar presentation of ectopic pregnancy?

A
  • PID
  • dysfunctional uterine bleeding
  • spontaneous abortion
  • ovarian cysts
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46
Q

was are risk factors of ectopic pregnancy?

A
  • tuba abnormality
  • previous tubal pregnancy
  • Hx of tubal reconstructive surgery
  • PID
  • IUD
  • increased maternal age
  • increased parity
  • previous cesarean section
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47
Q

what are increased risks with infertility?

A
  • ovulation induction
  • IVF
  • Embryo transfer
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48
Q

if you have an increased risk with infertility what else may you be at risk for?

A

ectopic and heterotopic pregnancy

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49
Q

what is the most common reason for morbidity?

A

bleeding

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50
Q

what are the hCG levels in ectopic pregnancy?

A

lower than in normal pregnancy

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51
Q

what in very important in clinical tests for ectopic pregnancy?

A

serial hCG

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52
Q

what must you see if hCG is present?

A

gestational sac

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53
Q

how fast does GS grow?

A

1 cm per week

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54
Q

how much should hCG grow?

A

double every 2-3 days

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55
Q

why is transvaginal ultrasound used?

A
  • increased accuracy of diagnosis

- increased visual of intrauterine and adnexal findings

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56
Q

what are the sites of ectopic pregnancy?

A
  • ampulla or ithmus
  • intramural portion
  • cervix
  • ovary
  • abdominal
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57
Q

what is the most common site of ectopic pregnancy?

A

ampulla or isthmus

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58
Q

what is the most vascular increase risk of massive bleeding?

A
  • intramural portion of tube
  • cervix
  • ovary
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59
Q

what is another name for intramural location of ectopic pregnancy?

A

interstitial ectopic (cornual)

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60
Q

why is intramural location ectopic pregnancy hard to detect?

A

myometrium covers tube in this region

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61
Q

when may their be a late rupture for intramural ectopic pregnancy?

A

3-4 months

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62
Q

is there bleeding for intramural ectopic pregnancy?

A

+++bleeding

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63
Q

what do you have a higher risk for in intramural location of ectopic pregnancy?

A

higher morbidity rate

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64
Q

what may be seen on ultrasound with intramural ectopic pregnancy?

A

interstitial line sign

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65
Q

what does the interstitial line sign look like on ultrasound?

A

thin, echogenic line extending from the endo canal to the interstitial sac or ectopic site

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66
Q

what is absent with intramural ectopic pregnancy?

A

no double-decidual sign

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67
Q

what is the treatment of intramural ectopic pregnancy?

A
  • surgical laparotomy & cornual resection

- methotrexate therapy

68
Q

cervical scar implantation ectopic

A
  • painless vaginal bleeding
  • Hx of cesarean sections
  • can look similar to spontaneous abortion
69
Q

what is cervical scar implantation?

A

sac implanted in lower uterine segment and local myometrial thinning

70
Q

what happens with cervical scar implantation?

A

+++vascularity at implantation site

no D&C due to thin myometrium

71
Q

what nay happen with cervical scar implantation?

A

catastrophic hemorrhage

-one sav detached “no vascularity”

72
Q

what is the treatment of cervical scar implantation?

A

complete hysterectomy

73
Q

what is an increased risk to get cervical ectopic pregnancy?

A

Hx of D&C

74
Q

how does vascularity determine cervical ectopic pregnancy?

A

implantation-vascular

incomplete abortion-nonvascular

75
Q

what is the treatment for cervical ectopic pregnancy?

A

medical injection KCl (potassium chloride)

76
Q

what is abdominal pregnancy treated like?

A

diagnosed in 1st trimester and treated like a tubal ectopic

77
Q

what are the sonographic appearances of ectopic?

A
  • donut sign
  • live fetal pole
  • decidual reaction
  • free fluid
78
Q

is heterotropic gestation rare or common?

A

very rare

79
Q

what is heterotropic gestation?

A

intrauterine pregnancy and an ectopic pregnancy occurring simultaneously

80
Q

what excludes an heterotopic gestation from ectopic?

A

Intrauterine pregnancy

81
Q

when may you suspect heterotopic gestation?

A

patient IVF
Ov. Induction
ET

82
Q

when is heterotopic gestation definitely diagnosed?

A

if live embryo in adnexa and IUP

83
Q

what are some abnormalities of the cervix?

A 
Nabothian cysts
cervical polyps
leiomyomas
cervical carcinoma
cervical cerclage
84
Q

what is the size of Nabothian cysts?

A

4cm

85
Q

Nabothian cysts

A
  • single or multiple
  • benign
  • simple or have internal echoes
  • multiple cysts can result enlargement of cervix
86
Q

cervical polyps

A
  • cause vaginal bleeding

- can be seen U/S usually diagnosed clinically

87
Q

leiomyomas 8% cx

A
  • pedunculated

- may prolapse into vagina

88
Q

cervical carcinoma

A
  • usually diagnosed clinically
  • U/S may show solid retro vesical mass (look like a fibroid)
  • MRI is best
89
Q

adenoma malignum

A
  • rare
  • associated Peutz-jeghers syndrome inherited
  • U/S appears as multiple cystic areas seen within a sold cx mass
90
Q

what is the most common congenital abnormality of the female genital tract?

A

imperforate hymen

91
Q

what is gartner’s duct cysts

A

remnants of caudal end of mesonephric cysts

92
Q

where can gartner’s duct cysts occur?

A

anterolateral or anterior wall of vagina

93
Q

what are the symptoms of gartners duct cyst?

A

asymptomatic

94
Q

what are the size of gartner’s duct cysts?

A

usually small

95
Q

what is gartner’s duct cysts associated with?

A

renal and ureteral abnormalities

96
Q

what may ultrasound not be used for in a diagnosis but may be used for staging?

A

vaginal pathologies

-neurofibroma

97
Q

what can cervical remnant be mistaken for?

A

mass

98
Q

what can cervical remnant measure?

A

4.4 mm AP and 4.3 mm length

99
Q

what may happen after hysterectomy?

A

vaginal cuff and cervical cuff after hysterectomy mistaken for mass

100
Q

what is the vaginal cuff upper limit?

A

TV-2.2mm (AP)

TA-2.4mm (AP)

101
Q

hydro

A

fluid

102
Q

pyo

A

puss

103
Q

hemat

A

blood

104
Q

colpos

A

vagina

105
Q

what could fluid in the PCDS be from?

A

blood or fluid from follicular rupture or retrograde menses

106
Q

what is PCDS fluid collections seen with?

A
  • general ascites
  • blood (ruptured ectopic or hemorrhagic cyst)
  • pus (infection)
  • PID
107
Q

anechoic PCDS fluid

A

serous fluid

108
Q

fluid containing echoes in PDCS

A

blood
pus
mucin
(clotted blood can look echogenic)

109
Q

why may fluid not suppost to be in cul-de-sac be there?

A
  • pelvic abscesses

- hematomas

110
Q

are congenital anomalies of fallopian tubes rare or common?

A

rare

111
Q

what are some abnormalities of fallopian tubes?

A
  • pregnancy (ectopic)
  • infection (PID)
  • torsion
  • neoplasm
  • scarring & obstruction due to other causes
112
Q

why would we look at fallopian tubes

A

important to determine adnexal cyst verus fluid filled tube “hydrosalpinx” (asymptomatic)

113
Q

tubal torsion is usually with what?

A

ovary torsion

114
Q

isolated torsion of fallopian tubes

A
  • paratubal cysts
  • chronic hydrosalpinx
  • tubal torsion & hydrosalpinx
115
Q

what will the patient present with for tubal torsion?

A

severe pelvic pain

116
Q

what may be the initial development of high grade serous cystadenocarcinomas?

A

fallopian tube carcinoma

117
Q

how is fallopian tube carcinoma managed?

A

same as ovarian cancer

118
Q

if a patient has fallopian tube carcinoma what can a ‘minority of patents’ present with?

A

hydrops tubae profluens (profuse watery discharge)

119
Q

where is the most common place to see fallopian tumor?

A

distal end of tube more common or entire

120
Q

what does fallopian tumor look like?

A
  • sausage shaped

- solid or cystic mass with papillary projections

121
Q

Dx of fallopian tube tumor can be considered if________

A

solid “mobile” vascular mass with normal ovaries

122
Q

what are vascular abnormalities in the adnexa?

A
  • ovarian vein thrombosis or thrombophlebitis

- pelvic congestion syndrome

123
Q

is ovarian vein thrombosis or thrombophlebitits common or rare?

A

rare

124
Q

when may ovarian vein thrombosis occur?

A

48-96 hours post partum

125
Q

what are S/S of ovarian vein thrombosis?

A
  • fever
  • lower abd pain
  • palpable mass
126
Q

which ovarian vein is mostly affected?

A

right ovarian vein 90% of the time

127
Q

what is good for diagnosing ovarian vein thrombosis?

A

CT & MRI

128
Q

what may ovarian vein thrombosis be seen on ultrasound?

A
  • inflammatory mass anterior to psoas and lateral to uterus

- ovarian vein

129
Q

what is treatment for ovarian vein thrombosis?

A

anticoagulant

antibiotic therapy

130
Q

what is pelvic congestion syndrome?

A

pelvic varices and reduced venous return

131
Q

what are S/S of pelvic congestion syndrome?

A
  • dull chronic pain worse when standing

- relieved with lying down and elevation of legs

132
Q

what is the diagnosis of pelvic congestion syndrome?

A

venography reference standard

133
Q

what may ovarian vein look like with pelvic congestion syndrome?

A
  • diameter over 5-10mm with reflux
  • uterine varicosities
  • congestion of ovarian plexus (tortous)
134
Q

what most commonly causes PID?

A

STI

  • gonorrhea
  • Chlamydia
135
Q

what are causes of PID?

A
  • STI
  • Direct Extension
  • hematogenous spread from TB rare (blood)
136
Q

what are signs and symptoms of PID?

A
  • pain
  • fever
  • chills
  • vaginal discharge
  • increased WBC
137
Q

how does PID enter the body?

A

outside to inside

-vagina-cervix-uterus (endometritis)-tubes (acute sapingitis)-into pelvis

138
Q

what increases the risk of PID?

A

IUCD

139
Q

what are long term problems of PID?

A
  • infertility
  • chronic pelvic pain
  • increased risk of ectopic pregnancies
140
Q

what are sonographic findings of PID?

A
  • endometritis
  • purluent material in cul-de-sac
  • periovarian inflammation
141
Q

periovarian inflammation

A

enlarged ovaries with multiple cysts and indistinct margins

142
Q

pyosalpinx

A
  • pus filled

- dilated, tortuous tubes with low level echoes

143
Q

hydrosalpinx

A
  • fluid filled
  • dilated tortuous tubes
  • anechoic
144
Q

what are different US appearances of tubal wall structure of PID?

A
  • cogwheel sign
  • beads on a string design
  • incomplete septa (waist sign)
145
Q

cogwheel sign

A
  • visible in cross section of tube
  • anechoic with thickened walls
  • acute disease
146
Q

beads on a string design

A
  • hyperechoic mural nodules within fluid filled tubes

- chronic disease

147
Q

incomplete septa (waist sign)

A
  • hyperechoic septa (acute and chronic)

- good for differentiating hydrosalpinx from other adnexal masses

148
Q

as infection worsens-tubo ovarian complex

A
  • increased echogenicity of inflamed fat
  • fusion of the inflamed tube with the ovary (adhesions)
  • ovary is visible does not separate from the tube with TV
149
Q

what is the worse outcome of PID?

A

tubo-ovarian abscess

150
Q

what does tubo-ovarian abscess look like?

A

-complex, multiloculated mass
-septations
-irregular margins
-scattered internal echoes
-usually posterior enhancement
-fluid-debris level or gas can sometimes be seen
CLINICAL CORRELATION IS NEEDED TO DETERMINE B VS M

151
Q

ultrasound for PID

A
  • useful for making initial diagnosis of PID

- help with determining pt managment

152
Q

trans abdominal for PID

A

extent of disease

153
Q

transvaginal for PID

A

better detail

154
Q

treatment of PID for mild to moderate cases?

A

outpatient antibiotics

-follow up is then needed

155
Q

treatment for ovarian abscess

A

hospitalization IV antibiotics

-follow up then needed

156
Q

what happens if antibiotics fail?

A

-US guided TV aspiration and drainage in combo with antibiotics

157
Q

what are some post operative pelvic masses?

A
  • Abscesses
  • Hematomas
  • Lymphoceles
  • Seromas
  • Uriomas
158
Q

what does an abscess pelvic mass look like?

A
  • ovoid
  • anechoic
  • thick, irregular walls
  • posterior enhancement
  • variable internal echogenicity
  • shadowing from gas
159
Q

what do hematoma pelvic masses look like?

A
  • variable appearances with time (start anechoic and end anechoic)
  • can be hard to distinguish hematoma and abscess
160
Q

lymphoceles

A
  • disruption of lymphatic channels

- cystic

161
Q

uriomas

A
  • cystic

- collection of urine

162
Q

seromas

A
  • cystic

- collection of serum

163
Q

pseudomasses

A

fecal material in rectum or rectosigmoid colon

164
Q

bowel neoplasms usual appearance

A

target sign

-central echogenic focus with thickened hypo echoic wall

165
Q

pelvic abscesses RLQ

A
  • appendicitis

- chron’s

166
Q

pelvic abscesses LLQ

A

diverticular disease

Pelvic (5 decks)

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