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Female Pelvis > Sonographic Evaluation of the Female Pelvis Ch 42 > Flashcards

Sonographic Evaluation of the Female Pelvis Ch 42 Flashcards

1
Q

Patient Prep & History

A
  • Date of LMP
  • Gravidity & Parity
  • Symptoms
  • Family History
  • Past Surgeries/Biopsies
  • Lab Tests
  • Hormone Regimen
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2
Q

Transabdominal

A

transducer placed at lower abdomen/pelvic area, full bladder

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3
Q

Transvaginal

A

an internal pelvic
exam, empty bladder

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4
Q

documentation uterine shape, size, orientation

A
  • Length measured in long axis
    from fundus to cervix
  • AP depth in long axis from
    anterior to posterior walls
    (perpendicular to length)
  • Width measured from transverse
    approach
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5
Q

documentation endometrium

A

Thickness of endo measured, analyze echogenicity

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6
Q

documentation cervix

A

Diameter measured with pregnancy

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7
Q

documentation myometrium (fibroids, irregularities)

A

Evaluated for contour changes,
echogenicity, masses

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8
Q

Adnexa- Ovaries & Fallopian
Tubes

A
  • Evaluate ovaries- size & shape
  • Position relative to uterus (Left?
    Right?)
  • Fallopian tubes not always seen
    sonographically, document if seen
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9
Q

Cul-De-Sac

A
  • Evaluate for free fluid or mass
  • Differentiate normal bowel loops from
    mass
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10
Q

If a mass is detected anywhere in

A

pelvis, document size, location, echogenicity related to uterus and ovaries

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11
Q

Evaluation of a Mass

A
  • Location- intrauterine or extrauterine
  • Size- length, AP, width
  • External Contour- smooth or irregular borders? well-defined margins or ill-defined?
  • Internal Consistency- cystic, complex, solid
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12
Q

Transabdominal Scanning Protocol Sagittal plane:

A
  • cervix, endocervical canal
  • posterior cul-de-sac
  • uterus (midline, right, and left)
  • endometrium
  • right ovary and adnexa
  • left ovary and adnexa
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13
Q

Transvaginal Scanning Protocol Sagittal: Uterus

A
  • Image from cervix to fundus, endometrial cavity: measure long axis
  • Angle slowly to right of uterus
  • Angle slowly to left of uterus
  • Pull probe out slightly to image cervix
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14
Q

Transabdominal Scanning Protocol Transverse plane:

A
  • vagina, cervix and posterior cul-de-sac
  • uterine corpus/body and endometrium
  • uterine fundus and endometrium
  • right ovary and adnexa
  • left ovary and adnexa
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15
Q

Transvaginal Scanning Protocol Coronal: Uterus

A
  • Rotate transducer 90 degrees; image
    uterine fundus, body, and cervix with
    endometrial canal
  • Look for free fluid surrounding
    uterine cavity.
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16
Q

Inner layer of uterus is

A

endometrium.

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17
Q

Endo layer is

A

thin, compact,
relatively hypovascular.

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18
Q

Thin outer layer separated from

A

intermediate layer by arcuate
vessels.

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19
Q

Normal arcuate vessels often seen
in

A

periphery of uterus and should not be mistaken for pathology.

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20
Q

Radial arteries arise as multiple
branches from

A

arcuate arteries and travel centrally to supply rich capillary network in deeper layers of
myometrium and endometrium.

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21
Q

ovaries are

A

mobile and can move considerably
in pelvis, depending on bladder volume
and whether woman has had previous
pregnancy.

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22
Q

Uterine location influences

A

position of ovaries.

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23
Q

ovaries are in shape

A

elliptical, with long axis usually oriented vertically.

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24
Q

Transvaginal scanning is superior for

A

characterizing texture of ovary.

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25
Ovary is located just
lateral to uterus and anteromedial to internal iliac vessel, which can be used as landmark to localize the ovary.
26
Transvaginally, the ovaries are easiest to locate in
transverse plane lateral to the cornua.
27
Not uncommon to find ovaries located
above uterus or posterior in rectouterine cul-de-sac area
28
ovary appearance changes with
age and menstrual cycle
29
ovaries are measured in
sagittal or longitudinal plane at longest length and anteroposterior dimension
30
ovaries in transverse or coronal scans,
width is measured at widest point.
31
Volume of ovary calculated using formula for prolate ellipse:
0.523 = length× thickness × width
32
uterus body separated from
cervix by isthmus at level of internal os and identified by narrowing of canal.
33
Uterus is usually
anteverted and anteflexed.
34
Uterus may also be
retroflexed when body tilted posteriorly or retroverted when entire uterus tilted backward.
35
Cervical canal extends from
internal os, where it joins uterine cavity, to external os, which projects into vaginal vault.
36
imaging the cervix the transducer inserted into
vagina with patient supine, knees gently flexed, hips elevated on pillow.
37
After uterine cavity examined,
probe should be slowly pulled back slightly to image internal and external cervical os.
38
imaging the cervix in sagittal view,
handle of transducer slowly moved upward and/or back to better image cervix.
39
imaging the cervix with gentle rotation and angulation of
transducer, coronal images also obtained.
40
cervix can frequently visualize
cervical inclusion cysts (nabothian cysts) near endocervical canal.
41
These cysts are generally
<1–2 cm wide; are anechoic smooth-walled structures with acoustic enhancement posteriorly.
42
Of no clinical significance and generally not
measured.
43
Sonographic appearance of
endometrial canal seen as thin echogenic line
44
endometrium consists of
superficial functional layer and deep basal layer
45
During menstruation (days 1 to 4), endometrial canal appears as
hypoechoic central line representing blood and tissue and reaching 4 to 8 mm, including basal layer.
46
During this phase of early menses,
acoustic enhancement posterior to endometrium may appear.
47
As menses progress (days 3 to 7),
hypoechoic echo that represented blood disappears and endometrial stripe is discrete thin hyperechoic line, usually only 2 to 3 mm.
48
Early proliferative phase (days 5 to 9)-endometrial canal appears as
single thin stripe- measuring 4-8mm
49
Functionalis layer seen as
hyperechoic halo encompassing it
50
Basalis layer of endometrium represents the
thin surrounding hyperechoic outermost echo.
51
Later proliferative phase (days 10 to 14)- endo becomes
thicker- measuring 6-10mm
52
Ovulation occurs toward the end of
proliferative phase.
53
During secretory (luteal) phase (days 15 to 28), endometrium at
greatest thickness and echogenicity, with posterior enhancement
54
Functionalis layer becomes
isoechoic with basalis layer.
55
Endometrial complex measures 7 to 14 mm during
secretory phase.
56
Endometrial thickness measured from
highly reflective interface of basalis layer of endometrium and myometrium in sagittal view
57
Rectouterine recess (posterior cul-de-sac) is most
posterior and inferior reflection of peritoneal cavity.
58
Located between rectum and vagina; also known as
pouch of Douglas
59
Posterior cul-de-sac frequently initial site for
intraperitoneal fluid collection
60
Gas and fluid-filled bowel loops are
poorly defined, echo-free mobile structures that usually demonstrate peristalsis under observation.
61
Solid material in bowel
hyperechoic and may produce shadowing, as does gas.
62
Sonohysterography also known as
saline infused sonography (SIS) or hysterosonography.
63
Sonohysterography involves .
instillation of sterile saline solution into endometrial cavity
64
Sonohysterography is used to
further evaluate endometrium when it exceeds normal thickness or shows focal areas of thickening and polyps suspected.
65
In premenopausal women, procedure is performed in
mid-menstrual cycle, usually between days 6 and 10.
66
Sonohysterography will prevent
possibility of disrupting early pregnancy and prevent blood clots artifactually filling some of endometrial cavity

Female Pelvis (5 decks)

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