reproductive pathology imaging Flashcards
1
Q
what imaging modality is usually used for the female reproductive system
A
ultrasound (not CT or MRI due to dose)
2
Q
which ducts did the uterus develop from and what are the 3 compartments/sections of the uterus
A
- developed from mullerian ducts
- fundus (top)
- body
- cervix (opening to vagina)
3
Q
what is the normal appearance of the uterus on an ultrasound
A
- trilaminar appearing structure
(dark, light, dark) ( light stripe is the endometrial lining) - smooth pear shaped organ
- thickness varies from 2-16mm
4
Q
what is hypo and hyperechoic
A
hypo echoic = dark on US (not many echos)
hyper echoic = bright on US (many echos)
5
Q
be aware that the uterus can be in different positions, anteverted or retroverted
A
6
Q
what is a unicronate uterus
A
- half a uterus
7
Q
what is a didelphic uterus
A
double uterus and double cervix
8
Q
what is a partial septate uterus
A
septum doesn’t extend to the cervix
9
Q
what is complete septate uterus
A
septum, runs down the middle of the uterus (i.e., the womb) and divides it into two separate parts
10
Q
what is a partial/complete bicornate uterus
A
partial fusion of Mullerian ducts resulting in a heart-shaped uterus instead of a pear shape
- lesser or stronger degree depending on if it is partial or complete
11
Q
what is arcuate uterus
A
mild indentation of the endometrium at the uterine fundus.
12
Q
what is the general issue associated with uterine abnormalities
A
- tight for baby development
13
Q
know what fibroids look like on radiographic scan, where are fibroids seen?
A
in pelvic region
14
Q
what are fibroids
A
benign growths developing around or in the uterus
15
Q
what are the 5 different places in the uterus that a fibroid can develop
A
- fundal subserosal (underneath serous membrane in fungus)
- subserosal
- intramural (in muscle)
- submucosal (beneath mucous membrane)
- pedunculate submucosal (closest to inner wall/inside of uterus)
16
Q
which ethnicity of women are more likely to get fibroids
A
african
17
Q
why is the suspected cause of fibroids
A
- high oestrogen
- nutritional factors e.g vitamin D deficiency
18
Q
fibroids usually shrink after menopause and pregnancy
A
19
Q
why might you experience pain with fibroids
A
- cramps as uterus is continuously trying to contract to remove fibroids
20
Q
must keep an eye out for fibroids as if they do not go on to shrink etc, they can become cancerous (leimyosarcoma)
A
21
Q
what are 4 symptoms of fibroids
A
- pelvic pain
- renal pain
- menorrhagia (heavy period)
- dyspareunia (painful intercourse0
22
Q
what is the endometrium of the uterus
A
- lining of uterus where the embryo is planted
23
Q
what is adenomyosis
A
endometrium invades the myometrium (invades muscle beneath it)
24
Q
how could you spot adenomyosis on ultrasound
A
- has the appearance of Venetian blinds
25
what is endometrial carcinoma
endometrial cancer
- also invades myometrium
26
how can you spot endometrial carcinoma on ultrasound
irregular outline and mixed echotecture
27
what do the ovaries produce (hormones)
- female reproductive cell / ova
- produces estrogen and progesterone
28
what 2 hormones stimulate the release of the ovum in the ovaries
LH
FSH
29
what is an ovarian cyst
fluid filed sac within ovary
30
how can you spot an ovarian cyst on ultrasound
- completely dark spots as they are fluid filled and so hypoechoic
31
what are 6 types of ovarian cysts
- haemorrhagic
- dermoid
- endometrioma
- mucinous cystadenoma
- functional
- malignante
32
what is a hemorrhagic cyst
- acute haemorrhage into corpus lute ( a temporary collection of cells that forms on your ovary each menstrual cycle if you're still getting a menstrual period)
- bleeds into itself
33
how can you spot hemorrhagic cyst on ultrasound
- nice and round BUT
- shows extra dark as theres blood within the cyst
34
what is a dermoid cyst + what is a germ cell
- contain elements from multiple germ cells
- germ cell is a cell that can become any cll
35
how can you spot a dermoid cyst
- can grow skin, hair, teeth, eyes nail etc
36
what is endometrioma
collection of endometrial tissue forming cyst
37
what 3 things can cause endometrioma
- seeding of endometrial tissiue into peritoneum
- activation of mesenchymal cells
- transformation of peritoneal epithelium into functional peritoneum
38
endometrioma occurs in up to 10% women of reproductive age
39
what are some symptoms of endometrioma
- pain
- dysmenorrhea (painful periods)
- dyspareunia
- infertility
40
what is endometriosis
- loosely spread endometrial tissue growing outside of uterine cavity
41
why is endometriosis painful
- loose endometrial tissue can cause adhesion of organs abnormally (painful)
42
what is mucinous cystadenoma
epithelial layer cyst containing mucin
- benign
43
how can the viewing of a mucinous cystadenoma vary on imaging
- hypo echoic feature of the cyst depends on level of mucin content
44
mucinous cystadenoma can grow very large and occupy much of pelvis, looking like a pregnant belly
45
what is a functional cyst
simple fluid filled
no discerning features
46
whats a malignant cyst
solid tumour
47
what is the difference between functional and malignant cyst on imaging
functional =
thin walled
well defined border with ovary
dark
malignant =
thick and irregular
very bright (on US)
poorly defined border
adhesion to other organs (causing pain)
48
when might a functional cysts become concerning
if the cyst does not heal/shrink on its own or continues to grow in size
49
what is PCOS
polycystic ovarian syndrome
50
what is the cause of PCOS
increased follicle release due to testosterone (approx 20), when follicle is released with no egg, it fills with fluid and forms cysts
51
what hormone is linked to causing PCOS
testosterone
- hence there abnormal hair grown
- overweight etc
52
what is used to diagnose PCOS
- ultrasound to see ovary
+
- clinical and biochemical assessments
53
common pathologies effect fertility by causing obstruction in fallopian tubes
54
ectopic pregnancies are due to issues with fallopian tube
55
how can chlamydia cause infertility
- brings about infection to the Fallopian tube
56
Fallopian tubes are too small to see on scans, hence what modality is used to see them
HSG = hysterosalpingogram
57
what is hysterosalpingogram
iodine based dye injected via catheter into uterine cavity to check tubal patency (if it is open)
- imaged as dye flows out of the tubes
- can be therapeutic as it can remove blockages
58
what is HyCoSy
hysterosalpingo contrast sonography
- combines dye and ultrasound
59
what are 2 most common types of tumours/cysts found in male scrotum
teretomas (similar to dermoid cysts can grow teeth etc)
seminomas
60
what is the usually resolution for testiular tumours
orchidectomy
- removal of testis
61
90% of intratesticular masses are malignant
many are asymptomatic and have non tender lumps
62
what is a seminoma
regular germ cell cancer
63
what population of males in specific get seminomas
any age group after puberty
64
what does a seminoma look like on ultrasound
hypoechoic
65
what is a teratoma
germ cell tumour
- painless mass
66
what population of males in specific get teratomas
pre pubescent
67
why is it important to remove teratomas before boys hit puberty
- after puberty the teratoma becomes malignant and aggressive
68
what is varicocoele
enlargement of veins in the spermatic cord
/dilation of pampiniform plexus
(due to pampiniform plexus not draining blood out)
69
why is varicocoele more common on the left side of testis
because of the relation of the spermatic vein to the left renal vein
- due to draining of testicular vein into renal vein at 90 degree
- man has more blood flow on that side
70
check kidneys with suspected vericocoele as it might be a kidney tumour causing increased venous pressure
71
what manouvre can dilate the pampiniform pelxus
valsalva manoucre
- deep breath, hold or puff out cheeck
72
what are the 4 symptoms of varicocele
- scrotal swelling
- pain
- testicular atrophy ( hence get smaller)
- subfertility
73
what is inguinal hernia
bowel or abdominal fat entering inguinal canal and can go down to scrotum
74
inguinal hernia can go down too far into scrotum, get strangulated and die
75
what is hydrocele
serous fluid collection in between layers of tunica vaginalis
fluid in scrotum
76
hydrocele can present as unilateral or bilateral swelling of scrotum
77
where is hydrocele most prevalent in
babies, as their testis have only just been pulled down
78
if you shine light on testis, it will glow/light shines through as there is hydrocele
79
what is epidydimo orchitis
inflammation of epidydimis and testis
80
what can be seen on the doppler scan due to epidydimo orchitis
increased vascular on colour doppler due to inflammatory response
81
what is the cause of epididymo orchitis
- infection from bladder or prostate spreading through ducts and lymphatic system reach down to epididymis and testis
82
what are symptoms of epididymis orchitis
- fever
- mild tenderness / scrotal pain
83
what are the 2 issues that can happen to the prostate
1. gets bigger
2. gets cancer
84
what is benign prostatic hyperplasia
enlarged prostate
85
what are 3 issues associated with enlarged prostate
- painful ejaculation
- can squash urethra and or ejaculatory duct
- can causer bladder or urinary issues
86
what is similar and different between cancer and enlarged prostate on ultrasound
both indent bladder wall
cancer= irregular borders
enlarged = smooth borders
