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Flashcards in FGT Deck (84):
1

What is the primary imaging modality for Female genital tract and pelvis?

UTZ

2

UtZ is used to:

Adjunct to PE to confirm the presence of pelvic mass:

-SIZE

-CONTOUR

-CHARCTER

-DETERMINE THE ORGAN OF ORIGIN

3

What is the function of UTZ?


•Evaluate for the involvement of other organs.
•Detect the presence of ascites, hydronephrosis and metastases.

4

What is Transabdominal UTZ?

It uses the urinary bladder as window to the pelvis

5

What is Transvaginal UTZ?


–Improve visualization of all lesions and to overcome the limited bladder filling and obesity
 

6

What is to overcome the limited bladder filling and obesity?

Transvaginal

7

What is the size of cervix in adult compared to prepubertal?

1/3 adult

2/3 prepubertal

 

8

What is the Dimension of Uterus in pospubertal?

9x6x4

9

What is the size of uterus in menopause?

6x2x2

10

______________________- most common uterine position of uterus

Anteverted

11

UTZ must always be correlated with the stage of 

menstrual cycle

12

What are the two things that UTZ affects in a normal uterus?

brightness and thickness of endometrium

13

At the end of menstruation the edometrium is________________

discrete

thing

2-3mm

14

In the proliferative change

Assume a 3 layer appearance

Anterior and posterior endometrium

Uterine cavity

15

In the secretory phase

Can go upto 14 mm

More uniformly echogenic

16

ADNEXAE

"FOBO"

1. OVARIES

2. FALLOPIAN TUBES

3. BROAD LIGAMENTS

4. OVARIAN AND UTERINE VESSELS

17

Describe the ovary in UTZ


•Oval soft tissue  structures with multiple small cystic follicles
 

18

What is the max size of the ovary?

Size maximum of 5 cm  in any one of dimension

 

19

What is the dimension of the ovary?

4x3x2 (+5cm)

20

What is the max volume of the ovary?

22 ml

21

What is use to best evualute the ovaries?

TVS

22

Ovaries shows characteristic morphological change during menstruation

 

23

Following menstruation, ovaries are at their smallest ____________

 

 measuring less than 5 mm

24

 – The ovary in this phace is that follicles enlarge with one dominant follicle attaining

20 – 25 mm by mid cycle

Estrogen phase

25

What is the apperance of the ovary in the Post Menopausal Ovaries?


•Atrophic
•Lack follicles
Difficult to visualize

26

What is the mean volume of the ovary at age 40-44

8 ml

27

The mean vol of ovary at age 70

<1.0 ml

28

What is the maximal volume in the post menopausal ovary?

29


–Not usually seen unless enlarged
 

Fallopian tubes

30

When can Broad ligament be seen ?


–Seen when outlined by fluid in the pelvis
 

31

What are the 3 groups of Disease in FGT?

  • benign
  • malignant
  • congenital

32

What are your Benign diseases?

1. Benign Cystic Teratoma

2.  PID

3. Tubo-ovarian Abcess

4. Endometriosis

5.Simple Ovarian Cyst

6. Complex Ovarian Cyst

7. Hemorrhagic Ovarian Cyst

8. Complex Adnexal Masses

9. functional Ovarian Cyst

10. PCOS

11. Uterine Leiomyomas

 

 

33

What is the MOST COMMON OVARIAN NEOPLASM?

Benign Cystic Teratoma

34

What is Benign Cystic Teratoma?


•Dermoid cyst
•Germ cell tumors
•10 – 30 years old


•Mature ectodermal elements:
–Bone, teeth and hair
 

35

What is the Imaging Modality of Choice of Benign Cystic Teratoma?

UTZ

36

What is the 3 common appearance of Benign Cystic Teratoma?


•3 common appearances:


–Cystic mass with complex fluid and mural node (dermoid plug)
–“Tip of iceberg appearance”
–Multiple fine echogenic strands
 

37

Cystic mass with complex fluid and mural node (dermoid plug)

“Tip of iceberg appearanceechogenic mass that fades into acoustic shadowing  because of sound absorption

Multiple fine echogenic strands

Benign Cystic Teratoma

38

What are the causes of PID?

STD

Secondary to instrumentation

39

What are the symptoms of PID


•Symptoms:
–Lower abdominal pain
–With or without vaginal discharge
 

40

This is a disease that does not need necessary imaging unless there is clinical uncertainty or suspected abscess?

Pelvic Inflammatory Disease

41



–Initial imaging modality of choice of PID
 

•Ultrasound

42

What is Tubo-ovarian Abscess in UTz?

Transvaginal ultrasound shows a thick walled septated left adnexal mass (arrow), in keeping with a tubo-ovarian abscess.

 



•Multi-locular complex retro-uretine/adnexal mass(es) with debris, septations, and irregular thick walls

 

43

In tubo-ovarian absecess, 
•Adjunct to ultrasound especially in determining the extent of disease.

44

What is the appearance of Tubo-ovarian Abscess in CT Scan


•Thick enhancing wall fluid density pelvic masses which may contain fluid- fluid levels or gas
 

45


•Benign but chronic inflammatory disease
 

Endometriosis 

46

What is the % of Endometriosis in childbearing age?


•10% - childbearing age
 

47

What is the percentage of women with infertility?

30%

48

Peirtoneum – ovary cul-de sac, bowel

Ectopic endometrium outside the uterus

 

49

Deep endometriosis: In the latter case, the____________ can

all be involved.

  •  genital tract,the
  • urological tract,
  • the abdominal wall and
  • the bowel

50

What are the symptoms of Endometriosis?


•Premenstrual abdominal pain
•Dysmenorrhea
•Chronic pelvic pain
•Dyspareunia
 

51

NO IMAGING TECHNIQUE IS PARTICULARLY USEFUL IN ENDOMETRIOSIS. T or F

T

52

What is the Gold standard for Endometriosis?


•Laparoscopy
 

53

What is the signal of Endometriosis in MRI inT1W1

HIgh

 

1st honor has HIgh grades

54

Endometriosis in MRI has ___________ signal intensity in T2w1


•Low signal intensity in T2WI
 

55

What is the reason of Low intensity signal in T2

 old blood due to recurrent hemorrhage

56

In edometriosis MRI 

1. Superficial lesion

2. On MRI these lesions are most often not visible because they are tiny and flat, and therefore undetectable. 


Only when they exceed ____________or when they___________, showing high signal intensity on T1 and low signal intensity on T2-weigthed images, they may be detected (figure).

  1. 5mm 
  2.  appear as hemorrhagic cysts

57

 

 

The sagittal T2-image shows full-thickness bladder endometriosis with isointense signal compared to muscle and foci of high signal intensity, indicating_______________

 

 dilated endometrial glands. 

58

What is the appearance of Endometrios in UTZ?

  • Mass
  • Maybe cystic
  • May contain particulate fluid

There is a mixed-to-hypoechoic, heterogeneous, lobulated mass in the subcutaneous tissue of the right lower quadrant. This mass is mobile and is clearly separate from the anterior abdominal wall muscles.  

59

What is the appearance of ovarian cyst in UTZ?

No internal echoes

Smooth walls

Good transmission of sound waves through the cyst to underlying structures.

60


SIMPLE OVARIAN CYST is •Very common
•Imaging modality of choice:

 

 

Ultrasound

61

What is the appearance of Simple Ovarian cyst in UTZ?

–No internal echoes
–Smooth walls
–Good transmission of sound waves through the cyst to underlying structures.

62


•Hemorrhagic and solid components
 

Complex Ovarian Cyst

63

What is the appearance of Complex Ovarian Cyst in UTZ?


•UTZ:
–Ground-glass
–Fenestrated

–Lacelike pattern
–NO solid components!
 

64

Q image thumb

Hemorrhagic Cyst–Layering Blood. Settling blood products produce a fluid-fluid layer (small arrows) within this hemorrhagic ovarian cyst shown on TV US. Large arrow indicates the direction of “up” during transvaginal scanning.

65

Complex Adnexal Masses 


•C – cystadenoma or cystadenocarcinoma
•H – hemorrhagic cyst
•E – endometrioma
•E – ectopic pregnancy
•T – teratoma (dermoid cyst)
•A - Abscess
•H – hematoma
 

66


•Most common ovarian mass
•Normal follicles:
–2.5 cm

 

Functional Ovarian Cyst

67

When is Functional Ovarian Cyst is pathological?

> 20 cm 

68

What is the reason when Functional cyst becomes pathological?

due to excessive accumulation of fluid or internal hemorrhage

69

Functional Ovarian Cyst appearance in UTZ



•Round
•Smooth
•Unilocular
•Resolves on follow-up after  1 or 2 menstrual cycle.
 

70


•Clinical and biochemical diagnosis
•Hirsutism, amenorrhea, infertility and obesity
 

Polycystic Ovarian Syndrome (PCOS)

71

How many percent in PCOS does 

Both ovaries are enlarged with multiple follicles (> 10 – 12 follicles per ovary)

•70%

72


•30% in PCOS have

 

–Completely normal ovaries

73

What population may have ovaries with multiple follicles but lack clinical features of PCOS

Patients with anovulatory menses especially young female atheletes 

74


Most common uterine tumor affecting  50% of women in reproductive age.
•Benign, smooth muscles with variable amount of fibrous tissues.
•Asymptomatic
•Can lead to excessive bleeding, pelvic pain, mass symptoms and infertility.

 

Most women are asymptomatic

Subserosa and submucosa maybe pedunculated

Uterine Leiomyomas

75



•Locations: Uterine LEIOMYOMAS
–Intramural
•Within the myometrial wall

 

–Intramural

76


•Beneath the endometrium
 

–Submucosal

77


•Beneath the serosa

–Subserosal

78

What part of Uterine Leiomyomas may be pedunculated?

Subserosa and submucosa maybe pedunculated

79

What is the signal of Uterine leiomyomas in MRI


•Both low signals in T1 and T2

MRI provides the best chaRActerization, number and location

80

What is the appearance of Uterine leiomyomas in CT scan?



•Heterogeneous or homogeneous masses
•Coarse calcification in the mass is common and Characteristic!
 

81

What is the characteristic of Uterine leiomyomas in CT scan?


•Coarse calcification in the mass is common and Characteristic!
 

82

What is the appearance of Uterine leiomyomas in XRAy?



•Calcification
•“Popcorn Appearance”
 

83

Uterine leiomyomas: X-ray



•Enlarged uterus
•Hypoechoic
•Acoustic shadowing
 

84