Chapter 3 — Pediatric Pelvic Sonography

Question 1

Normal newborn female sono findings
- cx is twice the elnger of the uterine body (cx 2/3 body 1/3)
- hyper echoic endo due to maternal hormones
- total length ~ 3cm AP .5 - 1 cm
- ov found anywhere between lower poles of kidneys and true pelvis

Question 2

after 2-3 months uterus regresses characteristics seen until puberty
- 2.5-3 cm total length, cx and body are equal (cx 1/2 body 1/2)
- endo stripe not delineated
- maintains infantile appearance until ~ 7yo
- small cysts may be seen on ov usually < 9mm may be as large as 17mm
- follicular development occurs prior to menarche (ovulation)

Question 3

At puberty gradually increases in length 5-7 cm body - cx ratio 3:1 (body 2/3 cx 1/3
Endo changed according to phase of cycle
Ov increase in volume and appearance varies with cycle

Question 4

Indications for peds imaging

Answer 4

• suspected ovarian cyst or complications of ovarian cysts
• assess ovaries when polycystic ovarian syndrome is suspected
• suspected ovarian neoplasms
• suspected congenital uterine anomalies
• determine the presence or absence of uterus and vagina in newborns with ambiguous genitalia
• evaluate uterus and ovaries in patients with precocious puberty
• suspected hematocolpos

Question 5

This is the onset of secondary sexual characteristic prior to age 8

Answer 5

Precocious puberty

Question 6

This is resulting from an early but normal pattern of gonadotropin secretion from the pituitary

• may be secondary to hypothalamic disease
• idiopathic in greater than 80% of cases
• may also be secondary to congenital adrenal hyperplasia.

Answer 6

True precocious puberty

Question 7

This is caused by abnormal exposure to estrogen
- results in development of secondary sexual characteristics without gametogenesis
- most often secondary to an ovarian tumor

Answer 7

Precocious pseudopuberty

Question 8

This a collection of blood within the vagina

Answer 8

Hematocolpos

Question 9

With this blood also extends into the cervix and uterine cavity

Answer 9

Hematometrocolpos

Question 10

In the pediatric patient, hematocolpos or hematometrocolpos is usually secondary to

Answer 10

Imperforated hymen

Question 11

Imperforate hymen clinical signs and symptoms:
- prwimary ammenorrhea
- lower abdominal pain
- possible lower abdominal/ pelvic mass

Question 12

Imperforate hymen sonographic findings
- hypochoic distention of vagina and/ or endometrial cavity
- posterior acoustic enhancementt
- internal echoes may be presen and represent debris or clot
- hydronephrosis may be present in cases of severe obstruction
- attempt should be made to identify possible other genitourinary anomalies