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Flashcards in GynObs Deck (23)
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1

Reliable morphologic criteria to diagnose IUP on TVS

Mean sac diameter 8mm - should see yolk sac

MSD 16mm - shd see embryo

CRL 5mm - shd see HR

2

Adnexal findings of an ectopic pregnancy

Free fluid
Adnexal mass : echogenic; ring of fire, gestational sac, yolk sac, fetal pole
Look for ovarian tissue around corpus luteum ( ovarian ectopic 1%)

3

Intrauterine findings in ectopic pregnancy
4

Normal ET
Thickened/heterogeneous
Decidual cysts
Pseudogestational sac ( 5%)

4

Mature teratoma
USS features
3

dot-dash pattern
Dermoid plug (echogenic)
Fat globules (echogenic)

5

Ovarian torsion
imaging findings
7

Enlarged > 4cm
Heterogeneous 40%
Follicles pushed to periphery 74%
Pelvic fluid 87%
Twisted vascular pedicle 88%
No flow 40%, no venous flow 33-93%
Lead mass ( mature dermoid) often > 4cm

6

Placental grading of maturity
4

0 - smooth chorionic plate, homogeneous substance

1 - random echogenic areas

2- basal echogenic line, comma like indentations in the chorionic plate

3 - echo poor areas in substance, deep indentations in the chorionic plate, irregular echogenic areas

7

Biophysical profile:
0-10 score
Each variable :
0-abnormal;
2 -normal

NST(FHR) - reactive
Fetal breathing - 1 episode of >20s within 30"
Fetal movement - min 2 discrete episodes
Fetal tone - 1 epi flexion/extension extremities or spine
AFV - > 2cm pocket

8

UA systolic/diastolic ratio
(placental end shows more end diastolic flow)

Varies with gestational age
Systolic velocity/diastolic (50th percentiles)
20/52 - 4
30/52 - 2.83
40/52 - 2.18

Opposite in fetal MCA( high RI is normal , always higher than UA) but decreases with GA.

9

Uterine adenomyosis
demo
Types
RF

premenopausal, multiparous
40-50, prior uterine surgery
HSG- pseudosacculations
MRI- T2 bright ectopic endometrial glands, T2 dark due to hypertrophic sm reaction
Diffuse - entire interface, > 12mm junctional zone (indirect)

Focal ( adenomyoma) - elliptical mass ( T2 bright foci)

Gradual enhancement
Elliptical shape
Lack of mass effect on endometrium
Ill-defined margins

10

Adenomyotic cyst

looks like an endometrioma in the myometrium

T2 bright surrounded by dark

Intramural or subserosal

11

Degeneration of fibroid types and RF

6

Non degenerated - well defined, homogeneous T2 low, post CE

Hyaline : low T2, var T1

Myxoid - V high T2, min CE

Calcific - low T2/signal void

Cystic - high T2, no CE

Red/haemorrhagic - infarction, peri/diffuse T1 high

Fatty

12

Cellular leiomyoma

Increased T2
Compact smooth muscle
homogeneous CE

13

Uterine Sarcoma
Types 4

mesenchymal
1-3%
Carcinosarcomas 40%
Leiomyosarcomas 40%
Endometrial stromal sarcomas 10-15%
Undifferentiated sarcomas 5-10%

14

Carcinosarcoma
demo
RF

v. aggressive
metaplastic (mixed)
post menopausal
1/3rd have hx pelvic irradiation
cf endo : larger, deeper myometrial invasion
Diff restriction ( inc cellularity)
CE more than endometrium

15

Leiomyosarcoma

1-2% uterine malignancies
>40 yrs
40% uterine sarcomas
Irregular margin
Variable T1/T2 SI
No Ca
Avidly CE

16

Endometrial carcinoma

PMB, ET > 5mm
2 types - endometrioid, papillary serous, clear cell

T2 intermediate SI relative to endometrium

CE- earlier than endometrium but LESS than normal myometrium

Diffusion restricts

17

Cervical cancer

FIGO clinical staging ( developing world)
T2 intermediate in cervical stroma ( Eq JZ)

18

MRI breast features of invasive ductal carcinoma

Rim/inhomogeneous CE
Plateau/washout
(enhances to atleast 60% above baseline)
(5% less CE)
multifocal disease
Nipple/chest wall involvement

19

Invasive lobular breast carcinoma MRI
demo

10-15%
mammogram underestimates 20-40%
upto 50% multifocal, bilateral
Typical washout CE
Architectural distortion

20

Inflammatory breast ca
MRI

skin CE + thickening
CE of coopers ligaments
Not MRI dx
Skin biopsy

21

Post radiotherapy changes in breast ca MRI

9-12m marked CE > patchy
18m - fibrosis and less CE

22

Fat necrosis on MRI

spiculated CE ( may have washout)
check non FS T1 ( central fat signal)

23

Benign Lymph node MRI characteristics

Typical reniform shape
Intense CE +/- washout
High T2 signal
Fatty hilum T1 non FS