Imaging-Pelvis, Scrotum Flashcards Preview

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Flashcards in Imaging-Pelvis, Scrotum Deck (33):
1

What structures are indicated in the image below?

Top = bladder. Bottom = seminal vesicles.

2

What structure is indicated below?

Prostate. Note its positioning in front of the rectum and between the femoral heads.

3

What structures are indicated below?

Ovaries. Note that their locations are very variable and can be deep or superficial.

4

What structure is indicated below?

Uterus. Note the multiple muscle layers.

5

What structures are indicated below.

Uterus. Note the myometrium and cervix on the left image. 

6

What can you see more clearly on a transvaginal ultrasound? What is a downside of transvaginal ultrasound?

The outline of the uterus and outline of the endometrium more clearly. The downside is that the field of view is more limited.

7

What structures are indicated in the image below?

Myometrium far left, Middle is endometrium and far right is the cervix.

8

What are the hypoechoic structures seen on the transvaginal ultrasound image below?

Follicles within the ovaries

9

What structures are indicated in the T2-weighted MR image below?

Left: myometrium Middle: endometrium Right: cervix

10

What structures are seen in this MR?

Normal ovaries. Note the follicles.

11

What would you expect to see on 5 week pregnancy ultrasound?

Note the perfectly round hypo echoic yolk sac.

12

What would you expect to see on 7 week pregnancy ultrasound?

Limb bud. The fetus changes very quickly in the 1st trimester. Note the 12 week image included below.

13

How many weeks old would you say this fetus is?

20. Note that you cannot fit the entire fetus in the image.

14

Why might you do a 30 week ultrasound?

To look at specific organs. The fetus is too large at this point to assess all structures.

15

This 35 year old woman presents to the ED with pelvic pain. Transvaginal ultrasound is shown below. What is causing her condition? How do you treat her?

Uterine fibroid. These are seen in 20-40% of women. Some women present with vaginal bleeding or pelvic pain, but most have no symptoms. These can be treated with uterine artery embolization, hysterectomy and focused ultrasound.

16

What is the best way to evaluate a uterine leiomyoma (fibroid)?

MRI

17

This 65 year old woman presented with abnormal uterine bleeding. What is causing her condition?

Note the thick endometrium with color flow. This means endometrial cancer.

18

Study of choice for diagnosing endometrial cancer

U/S. MRI is used for staging.

19

1st line imaging for female pelvis and male scrotum

U/S

20

A 45 year old woman presented with pelvic pain. What is causing her condition?

Note the solid, soft tissue mass in the adnexal areas indicating ovarian cancer.

21

Study of choice for diagnosing ovarian cancer

U/S. MRI or CT for staging.

22

A 25 year old woman presents with pelvic pain. U/S and CT are shown below. What is your diagnosis?

Note the dark fatty lesion on CT. This is an ovarian dermoid (dermoid cyst, ovarian teratoma, mature cystic teratoma), the fat on CT or MR is key in making this diagnosis. 

23

Benign ovarian lesion with fat on CT or MR

Ovarian mermaids are benign 95% of the time.

24

This 14 year old presents with acute scrotal pain. What is your diagnosis?

Note the absence of blood flow in the right testicle. This is diagnostic of testicular torsion, which is a surgical emergency (within 6 hours to save the testicle).

25

This 19 year old was kicked in the scrotum while playing soccer. What is your diagnosis?

Testicular rupture. Note that the testicle is not smooth and confined to the capsule like normal.

26

This 28 year old woman presented with worsening intermittent pelvic pain over 2 weeks. What is your diagnosis?

Note that the left ovary is brighter and 2x the size of the right ovary. This is an ovarian torsion. Pain is intermittent because the ovary torses, then detorses and continues the cycle and the ovary infarcts a little bit each time.

27

How does ovarian torsion differ from testicular torsion?

Although U/S is the diagnostic imaging choice, you can still have flow in an ovarian torsion. What you’re looking for in ovarian torsion is a big, bright ovary.

28

This 20 year old patient came in with a palpable testicular mass. What is your diagnosis?

Note the blood flow greater than flow in the testicle. This is testicular cancer.

29

Imaging study of choice for testicular cancer?

U/S for diagnosis and CT for staging.

30

A 38 year old woman presents with recent uterine artery embolization followed by vaginal bleeding and pain. What is your diagnosis?

Note the non-enhancing lesions indicating normal uterine fibroids after embolization. Often expelled fibroids will cause pain after embolization.

31

Imaging study of choice for uterine fibroids pre and post uterine artery embolization?

MRI

32

This 32 year old female presented with a positive beta-hCG. What is your diagnosis?

Molar pregnancy.

33

This 32 year old female presenting with a positive beta-hCG. What is your diagnosis?

Note the yolk and gestational sac. The straight line is an IUD that is no longer in the cervix.