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Week 4 - female GU/breast > Radiology - recognising common pathologies of the female genital tract > Flashcards

Radiology - recognising common pathologies of the female genital tract Flashcards

1
Q

A

A

Infundibulum

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2
Q

B

A

fundus

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3
Q

C

A

Fallopian tube

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4
Q

D

A

Fimbrae

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5
Q

E

A

Broad ligament of ovary

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6
Q

F

A

endometrium

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7
Q

g

A

Myometrium

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8
Q

h

A

vagina

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9
Q

i

A

Cervix

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10
Q

j

A

Body of uterus

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11
Q

k

A

Ovary

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12
Q

l

A

Vaginal vault

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13
Q

Why is important to have a full bladder for a trans abdominal ultrasound scan of the uterus?

A

The US waves can easily pass through fluid resulting in an ‘acoustic window’ allowing for a clearer image of the uterus and ovaries etc.

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14
Q

What colour is the endometrial stipe on an ultrasound scan?

A

White/brighter- it is hyper echoic in relation to fat

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15
Q

What colour is the endometrium in an ultrasound scan?

A

It is darker, it is hypo echoic in comparison to fat

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16
Q

What are the pros of a transvaginal ultrasound?

A
  • Better image of the uterus overall

* Doesn’t require a full bladder

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17
Q

What are the cons of a transvaginal ultrasound?

A
  • harder to see the ovaries

* More invasive

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18
Q

What are the cons of MRI for imaging of the female genital tract?

A
  • No metal - large magnet
  • Problem for those with claustrophobia
  • Loud
  • Takes a long time
  • Not so readily available
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19
Q

What are the pros of MRI for imaging of the female genital tract?

A
  • Good for soft tissue detail

* Best resolution out of imaging options and good for pathology

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20
Q

Explain the different colours on an MRI scan of the female genital tract with T2 sequence

A
  • Bright means fluid
  • Endometrial bright
  • Junctional zone dark
  • Myometrium in the middle
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21
Q

Label

A 
a- junctional zone
b- internal os
c- endocervix 
d- external os 
e- cervical stroma
f- myometrium
g- endometrium
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22
Q

What are the pros of using CT for imaging of the female genital tract?

A
  • Quick

* Good for seeing any metastases

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23
Q

What are the cons of using CT for imaging of the female genital tract?

A
  • Irradiating

* not the best for resolution but can use IV contrast

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24
Q

Benign ovarian pathologies

A
  • Ovarian follicles
  • Dermoid cysts
  • Haemorrhagic cysts
  • Endometriomas
  • Polycystic ovarian syndrome
  • Ovarian torsion
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25
Q

Why may the ovaries not be seen on ultrasound?

A
  • Bowel in the way
  • Fat
  • if post menopausal they shrink
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26
Q

Ovarian follicles

A
  • Common
  • benign
  • asymptomatic
  • Most don’t need follow up unless greater than 5cm in premenopausal or up to 3cm in post menopausal women
27
Q

Haemorrhagic cyst

A
  • Haemorrhage into a dominant follicle/funcitonal cyst
  • Asymptomatic or might present with pain
  • Follow up in 6 weeks- likely to disappear
28
Q

Describe haemorrhage cyst on ultrasound

A
  • Cyst with haemorrhage debris
  • Dark circle with white flecks throughout
  • If you put on the doppler will light up around the outside of the cyst but not inside
29
Q

Dermoid cyst

A
  • Often found incidentally in young women
  • Common benign neoplasm
  • Contain elements from multiple germ cell layers
30
Q

Dermoid cyst on x ray

A
  • Bright

* Calcification due to presence of bone/teeth

31
Q

Describe a dermoid cyst on ultrasound

A

Heterogenous mass, solid nodule

32
Q

Describe dermoid cyst on CT

A

The presence of fat/fluid/calcification/soft tissue almost fully confirms

33
Q

What is polycystic ovarian syndrome?

A
  • Chronic anovulation associated with excess of androgen
  • Clinical and/or biochemical hyperandrogenism
  • Multiple immature follicles due to development being stopped
34
Q

Describe polycystic ovaries on ultrasound

A

Lots of small dark circles in ovary

35
Q

What is ovarian torsion?

A

Ovary twists on its vascular pedicle

36
Q

Who is mainly affected by ovarian torsion?

A

Young women

37
Q

What do patients with ovarian torsion present with?

A
  • Abdomen/pelvic pain

* Nausea and vomiting

38
Q

What is an ovarian torsion associated with?

A

1/2 of the time associated with an ovarian mass e.g. a dermoid cyst

39
Q

Describe ovarian torsion on ultrasound

A
  • Enlarged ovary
  • Free fluid in the pelvis
  • Ovary may show absent vascularity (if using doppler) (may be ischaemia of the ovary due to reduced vascularity)
40
Q

What are the signs and symptoms of ovarian cancer?

A
  • Abdominal distension
  • Pelvic or abdominal pain
  • Feeling full and loss of appetite
  • increasing urinary urgency or frequency
  • irritable bowel syndrome > 50
41
Q

Describe the risk of malignancy index

A 
•RMI = ultrasound score x menopausal score x CA125 
•Menopausal score: 
 - premenopausal = 1
 - postmenopausal = 3
•Ultrasound score:
 - 0 =none 
 - 1 = one abnormality 
 - 3 = two or more abnormalities
42
Q

What RMI score is concerning for malignancy?

A

RMI of >200

43
Q

What are the features of malignancy on ultrasound?

A
  • Irregualr solid or multi-lobulated cystic mass
  • Solid components on cyst wall
  • Bilateral ovarian lesions
  • Ascites, peritoneal nodules, or evidence of metastases
44
Q

What are the types of ovarian carcinoma?

A
  • Epithelial

* Non epithelial

45
Q

What are the epithelial ovarian carcinomas

A
  • Serous (80-85%)
  • Mucinous (endocervical and intestinal phenotype)
  • clear cell
  • Endometroid
  • brenners
  • Squamous
46
Q

What are the non-epithelial ovarian carcinomas?

A

•Germ cell: dysgerminoma, teratoma etc.
•Sex chord:
- granulosa cell
- sertoli leydig, thecoma, fibroma

47
Q

Which cancers tend to metastasise to the ovaries?

A
  • Uterus
  • Colon
  • Breast
  • Lymphoma
  • Stomach and pancreas can drop metastasise
48
Q

Describe serous epithelial ovarian cancer

A
  • Most are benign but 25% are malignant

* Look like a large cystic mass on imaging

49
Q

what are the malignant features of serous epithelial cancer?

A
  • Thick separations
  • Solid components
  • Ascites, peritoneal metastases, lymphadenopathy, distant metastases
50
Q

What are the benign uterine pathologies?

A
  • Fibroids

* Adenomyosis

51
Q

What are fibroids

A

Most common solid benign uterine lesion

52
Q

Describe the presentation of fibroids

A
  • may cause pain, infertility or menorrhagia

* Usually found incidentally in post menopausal women

53
Q

Describe fibroids on ultrasound imaging

A

•Features are variable
•Hypoechoic mass on ultrasound
•Often make the uterus look bulky/lobulated

54
Q

What is andenomyosis?

A

When endometrial tissue has migrated into the myometrium

55
Q

Describe the presentation of adenomyosis

A 
•May be asymptomatic 
•May get:
 - dysmenorrhea 
 - menorrhagia 
 - dyspareunia (pain during intercourse) 
 - chronic pelvic pain
56
Q

Describe imaging of adenomyosis

A

thickening of the junctional zone with no uniform dark zone on MRI

57
Q

What are the investigations for endometrial cancer?

A
  • Initally a transvaginal US
  • If endometrial thickening is greater than 5mm then MRI to look for local invasion
  • CT to detect distant metastases
58
Q

What is the most common presentation of endometrial cancer?

A

Post menopausal PV bleeding

59
Q

What is cervical cancer mainly associated with?

60
Q

Presentation of cervical cancer

A
  • Vaginal bleeding
  • Abnormal discharge (foul smelling, brown, watery or mixed with blood)
  • Abnormal cervical cancer screening test
61
Q

What is the parametrium?

A

A fibrous band that separates the cervix from the bladder

62
Q

What is the significance of the parametrium in cervical cancer?

A
  • Stage 2b and above if invasion
  • If it is not invaded then surgery
  • If it is invaded then chemotherapy or radiation
63
Q

What is vaginal cancer often associated with?

A

Cervix cancer metastasis and HPV

64
Q

Describe the presentation of vaginal cancer

A

Lump, itch or bleeding that won’t go away

Week 4 - female GU/breast (7 decks)

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