Imaging-Pelvis, Scrotum

Question 1

What structures are indicated in the image below?

Answer 1

Top = bladder. Bottom = seminal vesicles.

Question 2

What structure is indicated below?

Answer 2

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

Question 3

What structures are indicated below?

Answer 3

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

Question 4

What structure is indicated below?

Answer 4

Uterus. Note the multiple muscle layers.

Question 5

What structures are indicated below.

Answer 5

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

Question 6

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

Answer 6

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

Question 7

What structures are indicated in the image below?

Answer 7

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

Question 8

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

Answer 8

Follicles within the ovaries

Question 9

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

Answer 9

Left: myometrium Middle: endometrium Right: cervix

Question 10

What structures are seen in this MR?

Answer 10

Normal ovaries. Note the follicles.

Question 11

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

Answer 11

Note the perfectly round hypo echoic yolk sac.

Question 12

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

Answer 12

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

Question 13

How many weeks old would you say this fetus is?

Answer 13

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

Question 14

Why might you do a 30 week ultrasound?

Answer 14

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

Question 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?

Answer 15

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.

Question 16

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

Answer 16

MRI

Question 17

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

Answer 17

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

Question 18

Study of choice for diagnosing endometrial cancer

Answer 18

U/S. MRI is used for staging.

Question 19

1st line imaging for female pelvis and male scrotum

Answer 19

U/S

Question 20

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

Answer 20

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

Question 21

Study of choice for diagnosing ovarian cancer

Answer 21

U/S. MRI or CT for staging.

Question 22

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

Answer 22

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.

Question 23

Benign ovarian lesion with fat on CT or MR

Answer 23

Ovarian mermaids are benign 95% of the time.

Question 24

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

Answer 24

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).

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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.

Question 27

How does ovarian torsion differ from testicular torsion?

Answer 27

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.

Question 28

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

Answer 28

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

Question 29

Imaging study of choice for testicular cancer?

Answer 29

U/S for diagnosis and CT for staging.

Question 30

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

Answer 30

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

Question 31

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

Answer 31

MRI

Question 32

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

Answer 32

Molar pregnancy.

Question 33

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

Answer 33

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