DOCSLIB.ORG

Bulky Uterus : What’S Beyond Disclosure Fibroids? the Authors Have No Disclosure of Funding Received Shweta Bhatt, MD for This Work from Any Organizations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bulky Uterus : What’S Beyond Disclosure Fibroids? the Authors Have No Disclosure of Funding Received Shweta Bhatt, MD for This Work from Any Organizations 3/28/21 Bulky Uterus : What’s beyond Disclosure fibroids? The authors have no disclosure of funding received Shweta Bhatt, MD for this work from any organizations. Professor of Radiology Mayo Clinic, Jacksonville, Florida Introduction/Objectives Normal Physiologic Appearance of the Uterus Woman of childbearing age: • Average length x width = 8.0 x 5.0 cm • Menstrual phase: • Endometrial thickness < 4mm Introduction: • Ill-defined myometrium with poor definition of the Junctional zone • The uterus is a dynamic organ that varies in appearance throughout a woman’s life. A • Proliferative phase: • Endometrial thickness 4-8 mm thorough understanding of its response to hormonal fluctuations and pregnancy is • Well defined zonal anatomy of endometrium, Junctional zone, and myometrium necessary for distinguishing between normal variation and abnormal enlargement. • Secretory phase: Additionally, a multitude of neoplastic processes can cause diffuse or focal enlargement, • Endometrial thickness 8-16 mm • making the diagnostic process quite challenging. Increasing thickness of the endometrium and myometrium with well defined zonal anatomy Postmenopausal woman: Objectives: • Average length x width = 5.0 x 2.0 cm • • Endometrial thickness <5mm Review the normal physiologic variation in size and appearance of the uterus • Myometrium becomes isointense with Junctional zone • Review the normal physiologic appearance of the postpartum uterus • Review the most common causes of uterine enlargement • Discuss their imaging appearance across multiple modalities with a focus on ultrasound and MRI • This educational exhibit is intended for the general radiologist or radiology resident Menstrual Proliferative Secretory Postmenopausal Causes of Uterine Enlargement Physiologic Enlargement: Hormonal Causes Physiologic Peripartum Anatomic Vascular Neoplastic Abnormal physiologic enlargement of the uterus is most commonly due to excess circulating estrogen/progesterone from either exogenous or endogenous Pelvic Congestion Myometrial Hormonal Delay of Involution Adenomyosis Syndrome Neoplasm sources • Exogenous causes (Common): Retained Arteriovenous • Tamoxifen (See next slide) Myometrial Placenta/Products Malformation Endometrial Contraction Cervical Stenosis Neoplasm of Conception (AVM) • Oral contraceptives • Typically combination of estrogen and progesterone Mullerian Duct Cervical • Most common imaging findings: Endometritis abnormalities Neoplasm • Globular enlargement of the myometrium • Atrophy of the endometrium Gestational Gestational Trophoblastic Trophoblastic Neoplasm Neoplasm • Endogenous causes (Rare): • Hormone producing adnexal tumor • Similar imaging findings as Tamoxifen from estrogen or gonadotropin Lymphoma producing effects Metastases 1 3/28/21 Physiologic Enlargement: Physiologic Enlargement: Tamoxifen related changes Myometrial Contraction • Contraction of the endometrial/subendometrial complex producing a mass-like Tamoxifen related changes: A - Pro-estrogen effects on the uterus convexity into the endometrial canal - Causes spectrum of changes including: • Does not deform the outer uterine contour - Endometrial Polyp (Most common) • Transient: Resolves within 45 minutes - Endometrial Hyperplasia • Best seen with cine MRI although can be seen between multiple acquisitions - Cystic Atrophy over the course of a non-cine MRI - Endometrial Carcinoma - Adenomyosis Most Common Ultrasound Features: Sagittal grayscale ultrasound image demonstrates - Hyperechoic endometrial thickening (≥ 8mm) with hyperechoic endometrial thickening with cystic spaces multiple irregular cystic spaces B Most Common MRI Features: - T1WI: Isointense endometrial thickening - T2WI: Heterogeneous endometrial thickening +/- endometrial/subendometrial cysts Best Diagnostic clue: - Clinical history of a breast cancer patient on Tamoxifen Sagittal T2WI demonstrates heterogeneous signal Most common presentation: throughout a widened endometrium with multiple - Irregular endometrial thickening with cystic spaces subendometrial cysts Sagittal T2WI Sagittal T2WI fat suppressed obtained 25 minutes later Normal Postpartum Appearance Peripartum Enlargement: Imaging Findings: • Endometrium: A Delay of Involution • Heterogeneous in appearance • Ultrasound: Endometrial canal filled with hypoechoic material Definition: A (fluid) and echogenic material (hemorrhage) - Delay in the expected decrease in size of the postpartum uterus • MRI: Endometrial canal filled with high T2 signal (fluid) and low T2 signal (hemorrhage) • Myometrium: Clinical Presentation: • Enlarged and typically of lower echogenicity (US)/higher T2 - Most commonly presents with abnormal postpartum bleeding signal (MRI) consistent with edematous changes. • Junctional zone: Imaging Findings: • Ill defined up to 6 weeks postpartum - Uterus larger than expected given time passed since delivery B - Persistence of fluid/hemorrhage in the endometrial canal Size: - Persistence of myometrial engorgement/edema B • The postpartum uterus gradually decreases in size over several weeks with the greatest decrease occurring during the 1st week Potential causes including: Mean Uterine Length Postpartum (cm) - Endometrial hematoma - Endometritis 15 13.8 - Retained products of conception 10.2 - Gestational trophoblastic neoplasm 10 8.6 6.1 - Leiomyomas - Uterine anomalies 5 Axial (A) and Sagittal (B) T2 fat suppressed MRI images in a patient 3 days post vaginal delivery. The Axial T1WI (A) and T2 fat suppressed (B) MRI 0 myometrium is diffusely enlarged with heterogeneous images in a patient 3 weeks postpartum. The signal and cystic changes. The junctional zone is poorly uterus demonstrates persistent enlargement as 30 hrs 1 we ek 2 we eks 6 we eks defined. There is also low signal in the endometrial well as high T2 signal throughout the myometrium. canal consistent with hemorrhage (red arrow). D+C revealed endometrial hematoma Peripartum Enlargement: Endometritis Peripartum Enlargement: Retained Products of Conception Clinical Presentation: A - Fever and pelvic tenderness in a postpartum patient A - More common in complicated pregnancies (Premature rupture of membranes, prolonged labor, retained products, etc.) Clinical Presentation: - Pain and bleeding after a recent miscarriage, abortion, or delivery Imaging Findings: - Elevated hCG - Endometritis is a clinical diagnosis and imaging findings are frequently normal Imaging Findings: - CT is the most common modality ordered to assess for alternative - Ultrasound: Endometrial mass of heterogeneous echotexture with explanation of postpartum fever positive vascularity - Most common finding includes endometrial thickening with - CT/MRI: Heterogeneous endometrial mass with variable fluid/gas in the endometrial cavity enhancement B - Caveats: B - Thinning of the myometrium on any modality suggests mal- - Uncomplicated endometritis may have normal imaging implantation of the placenta (ie: placenta accreta, increta, percreta) findings - Gas in the endometrial cavity can be a normal finding Key differential diagnoses in a postpartum patient: within the first 3 weeks postpartum - Endometrial hematoma: No appreciable vascularity/enhancement - Serial exams may be helpful for distinguishing endometritis from - Gestational trophoblastic neoplasm: Markedly elevated hCG normal postpartum fluid/gas Best Diagnostic Clue: - Clinical history of fever and pelvic tenderness in a postpartum Sagittal (A) and axial (B) CECT in a patient 5 days post C-section demonstrates Sagittal T2WI (A) and T1+C (B) MRI images in a patient patient post abortion with a hCG 51 - Fluid and gas in the endometrial cavity thickened endometrium with fluid and gas demonstrates a heterogeneous endometrial in the endometrial cavity mass with avid contrast enhancement. 2 3/28/21 Peripartum Enlargement: Peripartum Enlargement: Gestational Trophoblastic Neoplasm Gestational Trophoblastic Neoplasm Background: A B • Comprises a spectrum of premalignant and malignant placental lesions • Premalignant lesions: Complete hydatidiform mole (CHM), Partial hydatidiform mole(PHM) • CHM: 46XX diploid, usually no fetal tissue present unless dizygotic twin pregnancy • PHM: Triploid, fetus/embryo present • Malignant lesions: Invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) • Invasive mole: A CHM or PHM that has invaded the myometrium • Choriocarcinoma: Abnormal proliferation of trophoblastic tissue that has often invaded myometrium and metastasized at time of diagnosis • PSTT: Focal neoplastic proliferation of trophoblasts in the myometrium at the site of placental insertion C D Imaging Findings: • GTN typically discovered as an absent/abnormal intrauterine pregnancy on prenatal ultrasound • CT/MRI can be used as follow up studies to assess for myometrial invasion or metastatic disease • CHM: Cystic endometrial mass with no associated embryo/fetus • PHM: Enlarged cystic placenta associated with an abnormal fetus • Invasive mole: Heterogeneous cystic endometrial mass invading into the myometrium • Choriocarcinoma: Heterogeneous echogenic mass with marked vascularity, often metastatic at time of diagnosis • PSTT: Heterogeneous echogenic mass with little vascularity. Can have cystic spaces like CHM/PHM. Key point: Sagittal grayscale (A) and color doppler (B) images in a patient 10 weeks from her last menstrual period - No reliable way to distinguish CHM, PHM, or miscarriage on imaging. Role of imaging is to identify abnormal with hCG 287,395. There is a heterogeneous, primarily isoechoic mass arising from the uterus
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • Recently Discovered Interstitial Cell Population of Telocytes: Distinguishing Facts from Fiction Regarding Their Role in The
    medicina Review Recently Discovered Interstitial Cell Population of Telocytes: Distinguishing Facts from Fiction Regarding Their Role in the Pathogenesis of Diverse Diseases Called “Telocytopathies” Ivan Varga 1,*, Štefan Polák 1,Ján Kyseloviˇc 2, David Kachlík 3 , L’ubošDanišoviˇc 4 and Martin Klein 1 1 Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] (Š.P.); [email protected] (M.K.) 2 Fifth Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] 3 Institute of Anatomy, Second Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; [email protected] 4 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] * Correspondence: [email protected]; Tel.: +421-90119-547 Received: 4 December 2018; Accepted: 11 February 2019; Published: 18 February 2019 Abstract: In recent years, the interstitial cells telocytes, formerly known as interstitial Cajal-like cells, have been described in almost all organs of the human body. Although telocytes were previously thought to be localized predominantly in the organs of the digestive system, as of 2018 they have also been described in the lymphoid tissue, skin, respiratory system, urinary system, meninges and the organs of the male and female genital tracts. Since the time of eminent German pathologist Rudolf Virchow, we have known that many pathological processes originate directly from cellular changes. Even though telocytes are not widely accepted by all scientists as an individual and morphologically and functionally distinct cell population, several articles regarding telocytes have already been published in such prestigious journals as Nature and Annals of the New York Academy of Sciences.
    [Show full text]
  • Nomina Histologica Veterinaria, First Edition
    NOMINA HISTOLOGICA VETERINARIA Submitted by the International Committee on Veterinary Histological Nomenclature (ICVHN) to the World Association of Veterinary Anatomists Published on the website of the World Association of Veterinary Anatomists www.wava-amav.org 2017 CONTENTS Introduction i Principles of term construction in N.H.V. iii Cytologia – Cytology 1 Textus epithelialis – Epithelial tissue 10 Textus connectivus – Connective tissue 13 Sanguis et Lympha – Blood and Lymph 17 Textus muscularis – Muscle tissue 19 Textus nervosus – Nerve tissue 20 Splanchnologia – Viscera 23 Systema digestorium – Digestive system 24 Systema respiratorium – Respiratory system 32 Systema urinarium – Urinary system 35 Organa genitalia masculina – Male genital system 38 Organa genitalia feminina – Female genital system 42 Systema endocrinum – Endocrine system 45 Systema cardiovasculare et lymphaticum [Angiologia] – Cardiovascular and lymphatic system 47 Systema nervosum – Nervous system 52 Receptores sensorii et Organa sensuum – Sensory receptors and Sense organs 58 Integumentum – Integument 64 INTRODUCTION The preparations leading to the publication of the present first edition of the Nomina Histologica Veterinaria has a long history spanning more than 50 years. Under the auspices of the World Association of Veterinary Anatomists (W.A.V.A.), the International Committee on Veterinary Anatomical Nomenclature (I.C.V.A.N.) appointed in Giessen, 1965, a Subcommittee on Histology and Embryology which started a working relation with the Subcommittee on Histology of the former International Anatomical Nomenclature Committee. In Mexico City, 1971, this Subcommittee presented a document entitled Nomina Histologica Veterinaria: A Working Draft as a basis for the continued work of the newly-appointed Subcommittee on Histological Nomenclature. This resulted in the editing of the Nomina Histologica Veterinaria: A Working Draft II (Toulouse, 1974), followed by preparations for publication of a Nomina Histologica Veterinaria.
    [Show full text]
  • Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department
    Current Problems in Diagnostic Radiology 48 (2019) 473À481 Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department Karen Tran-Harding, MD*, James T. Lee, MD, Joseph Owen, MD Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY ABSTRACT Women commonly present to the emergency room with subacute or acute symptoms of gynecologic origin. Although a pelvic exam and ultrasound (US) are the pre- ferred initial diagnostic tools for gynecologic entities, a CT is often the first line imaging modality in the emergency department. We will provide a review of normal uterine enhancement and normal pregnancy related findings, and then familiarize radiologists with the CT appearances of gynecologic entities classically described on ultrasound that may present to the emergency department. © 2018 Elsevier Inc. All rights reserved. Introduction lower attenuation than myometrium, its thickness varies with the menstrual cycle, and it should not be mistakenly described as blood Pelvic pain is a common reason for women to present to the emer- or fluid in the canal (Fig 1 A/B open arrowhead). During the menstrual gency department. Detailed menstrual, sexual, and surgical history, and cycle, the endometrium can measure anywhere from 1 mm during screening beta-human chorionic gonadotropin (hCG), are essential to menstruation and up to 7-16 mm during the secretory phase.1 differentiate
    [Show full text]
  • Gynecologic Pathology Grossing Guidelines Specimen Type
    Gynecologic Pathology Grossing Guidelines Specimen Type: TOTAL HYSTERECTOMY and SALPINGO-OOPHRECTOMY (for TUMOR) Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram [intact/previously incised/disrupted] [total/ supracervical hysterectomy/ total hysterectomy and bilateral salpingectomy, hysterectomy and bilateral salpingo-oophrectomy]. The uterus weighs [***grams] and measures *** cm (cornu-cornu) x *** cm (fundus-lower uterine segment) x *** cm (anterior - posterior). The cervix measures *** cm in length x *** cm in diameter. The endometrial cavity measures *** cm in length, up to *** cm wide. The endometrium measures *** cm in average thickness. The myometrium ranges from *** to *** cm in thickness. The right ovary measures *** x *** x *** cm. The left ovary measures *** x *** x *** cm. The right fallopian tube measures *** cm in length [with/without] fimbriae x *** cm in diameter, with a *** cm average luminal diameter. The left fallopian tube measures *** cm in length [with/without] fimbriae x *** cm in diameter, with a *** cm average luminal diameter. The serosa is [pink, smooth, glistening, unremarkable/has adhesions]. The endometrium is tan-red and remarkable for [describe lesion- location (fundus, corpus, lower uterine segment); size (***x***cm in area); color; consistency; configuration (solid, papillary, exophytic, polypoid)]. Sectioning reveals the mass has a [describe cut surface-solid, cystic, etc.]. The mass extends [less than/ greater than] 50% into the myometrium (the mass involves *** cm of the wall where the wall measures *** cm in thickness, in the [location]). The mass [does/does not] involve the lower uterine segement and measures *** cm from the cervical mucosa. The myometrium is [tan-yellow, remarkable for trabeculations, cysts, leiyomoma- (location, size)].
    [Show full text]
  • The Uterus and the Endometrium Common and Unusual Pathologies
    The uterus and the endometrium Common and unusual pathologies Dr Anne Marie Coady Consultant Radiologist Head of Obstetric and Gynaecological Ultrasound HEY WACH Lecture outline Normal • Unusual Pathologies • Definitions – Asherman’s – Flexion – Osseous metaplasia – Version – Post ablation syndrome • Normal appearances – Uterus • Not covering congenital uterine – Cervix malformations • Dimensions Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer To be avoided at all costs • Do not describe every uterus with two endometrial cavities as a bicornuate uterus • Do not use “malignancy cannot be excluded” as a blanket term to describe a mass that you cannot categorize • Do not use “ectopic cannot be excluded” just because you cannot determine the site of the pregnancy 2 Endometrial cavities Lecture outline • Definitions • Unusual Pathologies – Flexion – Asherman’s – Version – Osseous metaplasia • Normal appearances – Post ablation syndrome – Uterus – Cervix • Not covering congenital uterine • Dimensions malformations • Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer Anteflexed Definitions 2 terms are described to the orientation of the uterus in the pelvis Flexion Version Flexion is the bending of the uterus on itself and the angle that the uterus makes in the mid sagittal plane with the cervix i.e. the angle between the isthmus: cervix/lower segment and the fundus Anteflexed < 180 degrees Retroflexed > 180 degrees Retroflexed Definitions 2 terms are described
    [Show full text]
  • Understanding Mare Reproduction
    Know how. Know now. EC271 (Revised October 2011) UNDERSTANDING MARE REPRODUCTION Kathy Anderson Extension Horse Specialist University of Nebraska–Lincoln Extension is a Division of the Institute of Agriculture and Natural Resources at the University of Nebraska–Lincoln cooperating with the Counties and the United States Department of Agriculture. University of Nebraska–Lincoln Extension educational programs abide with the nondiscrimination policies of the University of Nebraska–Lincoln and the United States Department of Agriculture. © 1994-2011, The Board of Regents of the University of Nebraska on behalf of the University of Nebraska–Lincoln Extension. All rights reserved. UNDERSTANDING MARE REPRODUCTION Kathy Anderson Extension Horse Specialist University of Nebraska–Lincoln INTRODUCTION FUNCTIONAL ANATOMY Many producers who raise horses find breeding A correctly functioning reproductive tract is es- mares rewarding, yet frustrating. Mares and stal- sential to the potential fertility of a broodmare. The lions are traditionally placed in the breeding herd tract goes through various changes as a mare exhib- due to successful performance records, with little its estrous cycles. A good working knowledge of a consideration for their reproductive capabilities. mare’s anatomy and these changes will aid in early Horses are difficult breeders with an estimated identification of potential abnormalities. These foaling rate of below 60 percent. Various factors changes can easily be monitored through rectal pal- contribute to this, including long-erratic estrous pation or ultrasound by a veterinarian. cycles and an imposed breeding season that does The rectum is located above the reproductive not coincide with the mare’s natural breeding sea- tract allowing for a noninvasive examination of the son.
    [Show full text]
  • Female Pelvis Ultrasound Protocol
    Female Pelvis Ultrasound Protocol Reviewed By: Spencer Lake, MD Last Reviewed: February 2020 Contact: (866) 761-4200, Option 1 **NOTE for all examinations: 1. If documenting possible flow in a structure/mass, all color/Doppler should be accompanied by a spectral gate for waveform tracing **EXCEPTION: Fibroids do not need to have spectral tracing** 2. CINE clips to be labeled: -MIDLINE structures: “right to left” when longitudinal and “superior to inferior” or “fundus to cervix” when transverse -RIGHT/LEFT structures: “lateral to medial” when longitudinal and “superior to inferior” when transverse **each should be 1 sweep, NOT back and forth** **Kidneys do not need to be routinely imaged unless there is a uterine anomaly detected** Transabdominal: Full Bladder -Attempt to visualize all structures TA Transvaginal: Empty Bladder -In a majority of cases, TV imaging will be needed to visualize any structures not adequately visualized TA. When the sonographer believes structures to be optimally visualized transabdominally, clearance must be given by the radiologist prior to release of the patient. - TV imaging should not be performed if declined by the patient, in pediatric/not sexually active patients, or in patients who have had a vaginal delivery within 6 weeks (or discussed with radiologist). NOTE: -Most examination will be TA & TV -TV only can be performed if ordered by clinician **HOWEVER, if only TV is ordered and some anatomy is sub-optimally visualized or not seen at all, add (limited) TA to attempt visualization of missing structures** -Please comment on worksheet which measurements are to most accurate based on real-time scanning (TA or TV).
    [Show full text]
  • Myometrial Disorders Myometrium Echogenicity
    Myometrial Disorders Myometrium Echogenicity Mani Montazemi, RDMS Director of Ultrasound Education & Quality Assurancee Baylor College of Medicine Division of Maternal-Fetal Medicine Texas Children’s Hospital, Pavilion for Women Houston Texas & Clinical Instructor Thomas Jefferson University Hospital - Radiology Department Normal myometrium has a smooth even texture throughoutut Philadelphia, Pennsylvania Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Inhomogeneous Myometrium Myometrium Echogenicity ••TransientTransient ••RealReal 2 min later 5 min later Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Myometrium Echogenicity Myometrium Echogenicity S R A •Arcuate artery •Radial artery •Spiral artery Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Inhomogeneous Myometrium Focal Densities Sub-Endometrial ••DensitiesDensities Placental site nodule ––Small,Small, focal, well defined Myometrium Fibroid, Scar, IUD ••LucenciesorLucencies or holes ––VesselsVessels ––flow flow Outer myometrium Arcuate Calcification ––CystsCysts ––no no flow ••MassesMasses ––DiscreteDiscrete with a border ––fibroid fibroid ––Ill-definedIll-defined ––adenomyosis adenomyosis Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Endo/Subendometrial Densities Placental Site Nodules ••FocalFocal echodensityechodensityat at endo-myo junctionjunction ••ProbablyProbably persistent site of prior implantationimplantation ••FoundFound in
    [Show full text]
  • Reproductive Anatomy
    59 REPRODUCTIVE ANATOMY Section I - Female Reproductive Organs I. There are five major structures of the female anatomy that are important for board preparation. (See Table 3.5.1 - Female reproductive structures) Anatomy Notes • Endometrium grows and sheds each cycle • Endometrium (mucosa) (menses) Uterus • Myometrium (muscularis) • Fibroids (myometrium tumor) • Perimetrium (serosa) • Endometriosis (endometrium outside) • Infertility Ovaries • Releases 2° oocyte into peritoneal cavity • Infertility Fallopian • Fimbriae facilitate 2° oocyte to tube • STI → cilia damage → dysmotility → tube • Cilia to facilitate zygote to uterus ectopic pregnancy • Cervical cancer Cervix • Most distal part of uterus • Cervicitis • Circumferential fibrous band with central • Ruptured during first vaginal intercourse Hymen clearing • Imperforate hymen → hematocolpos • Located in distal vagina (blood accumulates in vagina and uterus) Table 3.5.1 - Female reproductive structures Figure 3.5.1 - Anterior view of the uterus 60 II. Endometriosis IV. Uterus-Peritoneal Connection A. Endometrial tissue outside the uterus leading to A. Fluid sent up through the vagina can reach the cyclical pain peritoneal cavity. This is because the Fallopian tubes empty directly into the peritoneal cavity. B. Secondary oocytes get released directly into the peritoneal cavity before being taken up by the fimbriae of the Fallopian tube. III. Fibroids A. Tumors of the myometrium (myomas). B. Can be located next to the endometrium (submucosal fibroids) or next to the perimetrium (subserosal fibroids). 61 Figure 3.5.2 - Sagittal view of female reproductive organs V. Imperforate hymen A. A hymen without a central clearing will accumulate blood after each menstrual cycle. This build-up is known as hematocolpos. 62 REVIEW QUESTIONS ? 1. A 23-year-old female patient volunteers for a 2.
    [Show full text]
  • The Female Reproductive System Part 2
    The Reproductive System The Female Reproductive System Part 2 Female Reproductive System Ovaries Produce female gametes (ova) Secrete female sex hormones Estrogen and progesterone Accessory ducts include Uterine tubes (oviducts, fallopian tubes) Uterus Maintains zygote development Vagina Receives male gametes Suspensory ligament of ovary Infundibulum Uterine tube Ovary Fimbriae Peritoneum Uterus Uterosacral Round ligament ligament Vesicouterine Perimetrium pouch Rectouterine pouch Urinary bladder Pubic symphysis Rectum Mons pubis Posterior fornix Cervix Urethra Anterior fornix Clitoris Vagina External urethral Anus orifice Urogenital diaphragm Hymen Greater vestibular Labium minus (Bartholin’s) gland Labium majus Copyright © 2010 Pearson Education, Inc. Figure 27.10 Ovaries Each about twice as large as an almond Retroperitoneal Ovarian ligaments Suspensory ligament of ovary Uterine (fallopian) tube Uterine Ovarian blood Fundus Lumen (cavity) tube vessels of uterus of uterus Ampulla Mesosalpinx Ovary Isthmus Mesovarium Infundibulum Broad Fimbriae ligament Mesometrium Round ligament of uterus Ovarian ligament Body of uterus Endometrium Ureter Myometrium Wall of uterus Uterine blood vessels Perimetrium Isthmus Internal os Uterosacral ligament Cervical canal Lateral cervical External os (cardinal) ligament Vagina Lateral fornix Cervix (a) Copyright © 2010 Pearson Education, Inc. Figure 27.12a Ovaries Follicles About 400,000 present at birth Some develop into mature ova at sexual maturity Maturation of a follicle occurs about
    [Show full text]