Radiology - recognising common pathologies of the female genital tract Flashcards
1
Q
A
A
Infundibulum
2
Q
B
A
fundus
3
Q
C
A
Fallopian tube
4
Q
D
A
Fimbrae
5
Q
E
A
Broad ligament of ovary
6
Q
F
A
endometrium
7
Q
g
A
Myometrium
8
Q
h
A
vagina
9
Q
i
A
Cervix
10
Q
j
A
Body of uterus
11
Q
k
A
Ovary
12
Q
l
A
Vaginal vault
13
Q
Why is important to have a full bladder for a trans abdominal ultrasound scan of the uterus?
A
The US waves can easily pass through fluid resulting in an ‘acoustic window’ allowing for a clearer image of the uterus and ovaries etc.
14
Q
What colour is the endometrial stipe on an ultrasound scan?
A
White/brighter- it is hyper echoic in relation to fat
15
Q
What colour is the endometrium in an ultrasound scan?
A
It is darker, it is hypo echoic in comparison to fat
16
Q
What are the pros of a transvaginal ultrasound?
A
- Better image of the uterus overall
* Doesn’t require a full bladder
17
Q
What are the cons of a transvaginal ultrasound?
A
- harder to see the ovaries
* More invasive
18
Q
What are the cons of MRI for imaging of the female genital tract?
A
- No metal - large magnet
- Problem for those with claustrophobia
- Loud
- Takes a long time
- Not so readily available
19
Q
What are the pros of MRI for imaging of the female genital tract?
A
- Good for soft tissue detail
* Best resolution out of imaging options and good for pathology
20
Q
Explain the different colours on an MRI scan of the female genital tract with T2 sequence
A
- Bright means fluid
- Endometrial bright
- Junctional zone dark
- Myometrium in the middle
21
Q
Label
A
a- junctional zone b- internal os c- endocervix d- external os e- cervical stroma f- myometrium g- endometrium
22
Q
What are the pros of using CT for imaging of the female genital tract?
A
- Quick
* Good for seeing any metastases
23
Q
What are the cons of using CT for imaging of the female genital tract?
A
- Irradiating
* not the best for resolution but can use IV contrast
24
Q
Benign ovarian pathologies
A
- Ovarian follicles
- Dermoid cysts
- Haemorrhagic cysts
- Endometriomas
- Polycystic ovarian syndrome
- Ovarian torsion
25
Why may the ovaries not be seen on ultrasound?
* Bowel in the way
* Fat
* if post menopausal they shrink
26
Ovarian follicles
* Common
* benign
* asymptomatic
* Most don't need follow up unless greater than 5cm in premenopausal or up to 3cm in post menopausal women
27
Haemorrhagic cyst
* Haemorrhage into a dominant follicle/funcitonal cyst
* Asymptomatic or might present with pain
* Follow up in 6 weeks- likely to disappear
28
Describe haemorrhage cyst on ultrasound
* Cyst with haemorrhage debris
* Dark circle with white flecks throughout
* If you put on the doppler will light up around the outside of the cyst but not inside
29
Dermoid cyst
* Often found incidentally in young women
* Common benign neoplasm
* Contain elements from multiple germ cell layers
30
Dermoid cyst on x ray
* Bright
| * Calcification due to presence of bone/teeth
31
Describe a dermoid cyst on ultrasound
Heterogenous mass, solid nodule
32
Describe dermoid cyst on CT
The presence of fat/fluid/calcification/soft tissue almost fully confirms
33
What is polycystic ovarian syndrome?
* Chronic anovulation associated with excess of androgen
* Clinical and/or biochemical hyperandrogenism
* Multiple immature follicles due to development being stopped
34
Describe polycystic ovaries on ultrasound
Lots of small dark circles in ovary
35
What is ovarian torsion?
Ovary twists on its vascular pedicle
36
Who is mainly affected by ovarian torsion?
Young women
37
What do patients with ovarian torsion present with?
* Abdomen/pelvic pain
| * Nausea and vomiting
38
What is an ovarian torsion associated with?
1/2 of the time associated with an ovarian mass e.g. a dermoid cyst
39
Describe ovarian torsion on ultrasound
* Enlarged ovary
* Free fluid in the pelvis
* Ovary may show absent vascularity (if using doppler) (may be ischaemia of the ovary due to reduced vascularity)
40
What are the signs and symptoms of ovarian cancer?
* Abdominal distension
* Pelvic or abdominal pain
* Feeling full and loss of appetite
* increasing urinary urgency or frequency
* irritable bowel syndrome > 50
41
Describe the risk of malignancy index
```
• RMI = ultrasound score x menopausal score x CA125
• Menopausal score:
- premenopausal = 1
- postmenopausal = 3
• Ultrasound score:
- 0 =none
- 1 = one abnormality
- 3 = two or more abnormalities
```
42
What RMI score is concerning for malignancy?
RMI of >200
43
What are the features of malignancy on ultrasound?
* Irregualr solid or multi-lobulated cystic mass
* Solid components on cyst wall
* Bilateral ovarian lesions
* Ascites, peritoneal nodules, or evidence of metastases
44
What are the types of ovarian carcinoma?
* Epithelial
| * Non epithelial
45
What are the epithelial ovarian carcinomas
* Serous (80-85%)
* Mucinous (endocervical and intestinal phenotype)
* clear cell
* Endometroid
* brenners
* Squamous
46
What are the non-epithelial ovarian carcinomas?
• Germ cell: dysgerminoma, teratoma etc.
• Sex chord:
- granulosa cell
- sertoli leydig, thecoma, fibroma
47
Which cancers tend to metastasise to the ovaries?
* Uterus
* Colon
* Breast
* Lymphoma
* Stomach and pancreas can drop metastasise
48
Describe serous epithelial ovarian cancer
* Most are benign but 25% are malignant
| * Look like a large cystic mass on imaging
49
what are the malignant features of serous epithelial cancer?
* Thick separations
* Solid components
* Ascites, peritoneal metastases, lymphadenopathy, distant metastases
50
What are the benign uterine pathologies?
* Fibroids
| * Adenomyosis
51
What are fibroids
Most common solid benign uterine lesion
52
Describe the presentation of fibroids
* may cause pain, infertility or menorrhagia
| * Usually found incidentally in post menopausal women
53
Describe fibroids on ultrasound imaging
• Features are variable
• Hypoechoic mass on ultrasound
• Often make the uterus look bulky/lobulated
54
What is andenomyosis?
When endometrial tissue has migrated into the myometrium
55
Describe the presentation of adenomyosis
```
• May be asymptomatic
• May get:
- dysmenorrhea
- menorrhagia
- dyspareunia (pain during intercourse)
- chronic pelvic pain
```
56
Describe imaging of adenomyosis
thickening of the junctional zone with no uniform dark zone on MRI
57
What are the investigations for endometrial cancer?
* Initally a transvaginal US
* If endometrial thickening is greater than 5mm then MRI to look for local invasion
* CT to detect distant metastases
58
What is the most common presentation of endometrial cancer?
Post menopausal PV bleeding
59
What is cervical cancer mainly associated with?
HPV
60
Presentation of cervical cancer
* Vaginal bleeding
* Abnormal discharge (foul smelling, brown, watery or mixed with blood)
* Abnormal cervical cancer screening test
61
What is the parametrium?
A fibrous band that separates the cervix from the bladder
62
What is the significance of the parametrium in cervical cancer?
* Stage 2b and above if invasion
* If it is not invaded then surgery
* If it is invaded then chemotherapy or radiation
63
What is vaginal cancer often associated with?
Cervix cancer metastasis and HPV
64
Describe the presentation of vaginal cancer
Lump, itch or bleeding that won't go away
