Coronal Uterine Anatomy and Imaging

Coronal uterine anatomy.

The uterine wall consists of three layers >The outermost layer is referred to as the serosal layer or perimetrium, which is continuous with the fascia of the pelvis.

> The middle layer is the myometrium or muscular layer,which constitutes the bulk of the uterine tissue, providing the area where contractile motion occurs.

• >The inner mucosal layer of the uterus is referred to
• as the endometrium. The endometrium can be further divided into a deep or

basal layer and a superficial or functional layer

Figure 17-3 Sagittal transabdominal image of the uterus demonstrating posterior to

• the distended urinary bladder (F), the uterine fundus (A), uterine corpus (B), uterine
• isthmus (C), cervix (D), and vagina (E)

Figure 17-3

• Figure 17-4 Endovaginal transverse image of the uterus demonstrating the
• myometrium (A), the endometrium (B), and the serosa (C).

Figure 17-4

Figure 17-5 Sagittal endovaginal image of the endometrium demonstrating the

• outermost basal layer (A), the innermost echogenic stripe of the uterine cavity (B),
• and the functional layer (C)

Figure 17-5

The thickness of the basal layer is typically consistent, although minimal changes may occur throughout the menstrual cycle.

The functional layer of the endometrium is the component that is shed during menstruation; thus, the thickness of the functional layer of endometrium will vary during the menstrual cycle as a result of hormonal stimulation.

The endometrial cavity,

also referred to as the uterine cavity, is located between the two functional layers of the endometrium. This cavity is contiguous with the lumen of the fallopian tubes laterally, and the cervix inferiorly.

Uterine Size and Shape

• The size and shape of the uterus depends on the age of the patient, parity, and
• the presence of pathology or congenital anomalies that may alter its contour
• The uterus is a hallow muscular walled, pear-shaped organ, flattened antero posteriorly.
• it lies in the pelvic cavity between the urinary bladder and rectum.
• uterus is about 7.5cm long, 5cm wide a
• its walls are about 2.5cm thick(7.5×5×2.5 ).
• Its weight is from 3o-40gms.Uterus has three parts which are fundus, body and cervix .
• fundus is the dome-shaped part of the uterus above the openings of the fallopian tubes.

Body is the main part occurs b/w the fundus and internal os of the cervix.

Cervix is also known as the neck of the uterus and occurs b/w the body of the uterus and vagina at the external os.structurally uterus has three layers/coverings which are perimetrium (outer most layer)

• ,myometrium (middle layer) and

endometrium (innermost layer)of the uterus.

Uterine Positions

• The uterine position within the pelvis is variable,
• The normal position of the uterus is considered to be

Anteversion or anteflexion.

Anteversion is the uterine position in which the body tilts forward or anteriorly, forming a 90-degree angle with the vagina.

Anteflexion of the uterus is the position in which the uterine body folds forward, possibly coming in contact with the cervix.

Retroversion of the uterus is the position in which the uterine body tilts backward or posteriorly, without a bend where the cervix and body meet.

Retroflexion is the uterine position that results in the uterine body tilting backward and actually coming in contact with the cervix.

anteversion

• retroversion
• retroflexion

antflexion

Retroverted

antiverted

Congenital Uterine Anomalies

Abicornuate uterus, also referred to as bicornis unicollis, is a common uterineanomaly that is present when the endometrium divides into two endometrial cavities with one cervix, with a prominent concavity noted in the outline of the uterine fundus.

The unicornuate uterus is present when the uterus has only one horn The subseptate uterus, which is characterized by an incomplete septum, has a normal uterine contour with an endometrium that branches into two horns.

The arcuate uterus is a subtle variant in which the endometrium has a concave contour at the uterine fundus.

The uterus didelphys is complete duplication of the vagina, cervix, and uterus The septate uterus, which is also describes a uterus that has two complete separate uterine cavities separated by an anteroposterior septum

TECHNIQUE AND POSITIONING

• Preparation
• Transabdominal imaging of the female pelvis
• requires the patient to have afull bladder.
• Patients are typically required to drink 32 ounces of water before the examination.
• Whether the bladder is retrofilled via a Foley catheter or filled

it must be distended adequately to visualize the entire uterus and adnexa This practice will provide an acoustic window via the bladder and also displace bowel from the field of view.

• NOTE
• Transivaginal does not requre full bladder

TECHNIQUES

• Sonography can be performed using
• transabdominal

endovaginal,also referred to as transvaginal, techniques.

Positioning:

• patient lie supine or lithotomy position for transivaginal technique

TYPES OF PROBE USED

• Curvex probe
• Intra-cavity/transvaginal probe

B-MODE

• Control amplification of returning echoes
• Controls overall brightness of the image
• An increase or decrease in over all gain changes image brightness
• Adjusts automatically if acoustic power is changed to maintaining brightness

M-MODE

• is a motion mode use for cardiac activity detection
• other useful mode
• depth
• focus
• zoom
• doppler mode
• measure/caliper mode

freeze mode

UTERINE PATHOLOGY

• Adenomyosis is the invasion of endometrial tissue into the myometrium

CLINICAL FINDINGS OF ADENOMYOSIS

• Uterine enlargement
• Boggy, tender uterus
• Dysmenorrhea
• Menometrorrhagia
• Pelvic pain
• Dyschezia
• Dyspareunia
• Multiparous

SONOGRAPHIC FINDINGS OF ADENOMYOSIS

• Diffusely enlarged uterus
• Hypoechoic or echogenic areas adjacent to endometrium
• Heterogeneous myometrium
• Myometrial cysts
• Ill-defined interface between myometrium and endometrium
• Thickening of the fundus or posterior myometrium

Uterine Leiomyoma also referred to as a fibroid or uterine myoma

CLINICAL FINDINGS OF A UTERINE LEIOMYOMA

• Pelvic pressure
• Menorrhagia
• Palpable pelvic mass
• Enlarged, bulky uterus (if multiple)
• Urinary frequency

SONOGRAPHIC FINDINGS OF LEIOMYOSARCOMA

• Rapidly growing mass within the uterus
• Hypoechoic mass within the uterus
• Posterior shadowing from the mass
• Degenerating fibroids may have calcifications or cystic components
• Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogeneous uterus
• Pyometra
• Pyometra is collection of pus in the uterus, mostly occur in elder woman .It may
• occur in any part of the uterus.
• Clinical features
• high grade fever
• Foul smelling discharge from vagina
• Causes
• inadequate hygienic condition ●Multi sexual woman ●aged female
• Sonological feature
• Size of the uterus will be enlarged.
• ii. It will be vary in size.
• iii. It will appear hyper/hypo echogenic.

iv. Can be present in any part of the uterus.

Nabothian Cyst

• benign retention cysts are located within the cervix and may cause
• cervical enlargement on physical examination.

SONOGRAPHIC FINDINGS OF A NABOTHIAN CYST

• Anechoic mass within the cervix
• May be multiple
• May be complex

PATHOLOGY OF THE CERVIX

• .Cervical Carcinoma and Cervical Stenosis

.Gartner Duct Cyst

4. Ovaries

• The ovaries are the female gonads (glands producing sex hormones and ova),
• they lies on the lateral walls of the pelvis.
• They are 2.5-3.5cm long, 2cm wide and 1cm thick.
• structurally ovaries has two layers which are;

1-Medulla which consists on fibrous tissue, blood vessels and nerves) and 2-Cortex, it surrounds the medulla and has a framework of connective tissue or stroma covered by germinal epithelium.

It contains ovarian follicles in various stages of maturity, each of which contains an ovum.

after puberty about every 28 days ,one or more ovarian follicle matures, and releases its ovum, which is called ovulation.

Function of ovaries

• The ovaries are the organs in which the female gametes are stored and
• develop prior to ovulation.
• Ovaries has endocrine functions in which they secretes hormones e.g.
• estrogen and progesterone which are responsible for the physiological
• changes after puberty;
• (a)The ovaries, uterine tube uterus reach to maturity.
• (b)The menstrual cycle and ovulation begins (menarch).
• (c) The breast develops and enlarges.
• (d)Pubic and axillary hairs begin to grow.
• (e) Increase in height and widening of the pelvis.

(f) Increase deposition of fats in the subcutaneous tissues ESP…at the hips and breast

Normal image of ovaries

• Ovaries will be normal in size i.e.(2.5×2×1).
• ii. They will located in their own position.
• iii. Sometimes follicles may seen in US which measures up to 5mm.

iv. Normal ovary will appear hypo echoic.

Ovarian cyst

• Accumulation of fluids in the ovaries is known as ovarian cyst. It has farther
• subtypes e.g.
• (a) Griffin follicles cyst_ it is simple cyst when ovarian follicles enlarged
• more than 2.5cm due to abnormal fluid accumulation. It forms griffin
• follicles cyst.
• (b) Corpus luteum cyst_ It produces during two menstrual cycles and
• ruptures at the time of menstrual phase.
• (c) Hemorrhagic cyst When small blood vessel enters into cyst wall and
• breaks in the cyst it forms hemorrhagic cyst.
• (d) Dermoid cyst_ abnormal growth of the egg (ova) is called dermoid

cyst. It can occur in any part of the ovary.

Benign Ovarian Disease

Follicular Cysts

CLINICAL FINDINGS OF FOLLICULAR CYSTS

• Asymptomatic
• Pain associated with hemorrhage and enlargement of cystysts

SONOGRAPHIC FINDINGS OF FOLLICULAR CYSTS

• Simple cyst–anechoic, thin walled, unilocular, round, posterior enhancement
• Hemorrhagic cyst—variable appearances, including complex components or entirely echogenic

Corpus Luteum Cysts (Corpus Luteal Cysts)

The corpus luteum cyst is a physiologic (functional) cyst that develops after ovulation has occurred.

• The corpus luteum is formed as a result of the rupture of the Graafian follicle

CLINICAL FINDINGS

• Asymptomatic
• Pain associated with hemorrhage and enlargement of cyst
• Corpus luteum of pregnancy accompanies a pregnancy

SONOGRAPHIC FINDINGS

• Simple cyst appearance
• May have a thick wall, be completely echogenic, and may be difficult to

differentiate from other solid and cystic adnexal masses

• Hemorrhagic components may appear complex or have a weblike or lacy appearance depending on the amount of blood and stage of lysis

Theca Lutein Cysts

CLINICAL FINDINGS

• Markedly elevated levels of hCG
• Nausea and vomiting
• Pelvic fullness
• Pain associated with hemorrhage, rupture, and ovarian torsion

SONOGRAPHIC FINDINGS OF THECA LUTEIN CYSTS

• Large, bilateral, multiloculated ovarian cystic masses
• May contain hemorrhagic components

Parovarian Cysts

• are small cysts located adjacent to the ovary, and most
• likely arise from the fallopian tubes or broad ligaments

CLINICAL FINDINGS

• Asymptomatic
• If cyst is large, patients may present with pelvic pain and increased lower
• abdominal girth

SONOGRAPHIC FINDINGS OF PAROVARIAN CYSTS

• Simple cyst located adjacent, but not attached, to the ovary
• If hemorrhagic, will appear complex

Cystic Teratoma (Dermoid)

Dermoids result from the retention of an unfertilized ovum that differentiates into the three germ cell layers.

CLINICAL FINDINGS

• Often asymptomatic
• If torsion or rupture occurs, the patient may present with acute pelvic pain

SONOGRAPHIC FINDINGS

• Complex, partially cystic mass in the ovary that includes one or more echogenic structures that may shadow
• “Tip of the iceberg” sign–only the anterior element of the mass is seen, while the greater part of the mass is obscured by shadowing
• Dermoid plug–produces posterior shadowing
• Dermoid mesh–produced by hair and will appear as numerous linear interfaces within the cystic area of the mass

Thecoma

CLINICAL FINDINGS

• May be asymptomatic
• Postmenopausal vaginal bleeding or abnormal vaginal bleeding secondary to
• estrogen stimulation
• Meigs syndrome (ascites and pleural effusion)

SONOGRAPHIC FINDINGS

• Hypoechoic, solid mass with posterior attenuation
• No posterior enhancement
• If large, it may mimic a pedunculated leiomyoma

Granulosa Cell Tumors

CLINICAL FINDINGS

• 1.Adolescence–pseudoprecocious puberty
• Reproductive-aged and postmenopausal women will have abnormal vaginal bleeding

SONOGRAPHIC FINDINGS

• Solid, hypoechoic mass
• Complex or partially cystic mass

Granulosa cell tumor. Longitudinal image of a 3-year-old girl suffering

• from premature breast development demonstrating a granulosa cell tumor (between

arrows) located posterior to the urinary bladder (B)

Fibroma

Brenner Tumor (Transitional Cell Tumor)

CLINICAL FINDINGS

• May be asymptomatic
• Meigs syndrome (ascites and pleural effusion)

SONOGRAPHIC FINDINGS OF A BRENNER TUMOR

• Small, solid, hypoechoic mass
• May contain calcifications

ENDOMETRIOMA

CLINICAL FINDINGS OF ENDOMETRIOMAS

• Patient may be asymptomatic
• Pelvic pain
• Infertility
• Dysmenorrhea
• Menorrhagia
• Dyspareunia
• Painful bowel movements (dyschezia)

SONOGRAPHIC FINDINGS OF ENDOMETRIOMAS

• Predominantly cystic mass with low-level internal echoes
• Anechoic or complex, mostly cystic mass with posterior enhancement and may have a fluid–fluid level
• Cystadenoma (Serous and Mucinous)

CLINICAL FINDINGS OF A SEROUS CYSTADENOMA

• Patients are often asymptomatic

SONOGRAPHIC APPEARANCE OF A SEROUS CYSTADENOMA

• Predominately anechoic lesion that contains septations and/or papillary

projections

CLINICAL FINDINGS OF A MUCINOUS CYSTADENOMA

• Pelvic pressure and swelling

SONOGRAPHIC APPEARANCE OF A MUCINOUS CYSTADENOMA

• Large, predominately anechoic lesion that contains septations and/or papillary projections
• May contain some recognizable internal, echogenic, layering debris

Malignant Ovarian Disease

• Cystadenocarcinoma (Serous and Mucinous)

CLINICAL FINDINGS OF SEROUS AND MUCINOUS

CYSTADENOCARCINOMAS

• Weight loss
• Pelvic pressure and swelling
• Abnormal vaginal bleeding
• Gastrointestinal symptoms
• Acute abdominal pain associated with torsion or rupture
• Elevated CA 125

SONOGRAPHIC APPEARANCE OF SEROUS

CYSTADENOCARCINOMA

• Large, multilocular cystic masses
• Papillary projections and septations are often noted within the mass
• Ascites

SONOGRAPHIC APPEARANCE OF MUCINOUS

CYSTADENOCARCINOMA

• Large, multilocular cystic mass
• Papillary projections and septations are often noted within the mass
• Echogenic material within the cystic components of the mass
• Pseudomyxoma peritonei (complex ascites)

Krukenberg Tumor

CLINICAL FINDINGS OF A KRUKENBERG TUMOR

• Asymptomatic
• History of gastric or colon cancer
• Possible weight loss
• Pelvic pain

SONOGRAPHIC FINDINGS OF A KRUKENBERG TUMOR

• Bilateral, smooth-walled, hypoechoic or hyperechoic ovarian masses
• “Moth-eaten” appearance (solid mass containing cystic spaces)
• May have ascites

Sertoli–Leydig Cell Tumors (Androblastoma)

CLINICAL FINDINGS OF SERTOLI–LEYDIG CELL TUMORS

• Virilization
• Abnormal menstruation
• Hirsutism

SONOGRAPHIC FINDINGS OF SERTOLI–LEYDIG CELL TUMORS

• Solid, hypoechoic ovarian mass
• Complex or partially cystic mass

Dysgerminoma

CLINICAL FINDINGS OF DYSGERMINOMA

• Children–pseudoprecocious puberty
• Elevated serum lactate dehydrogenase
• Possible elevated serum hCG

SONOGRAPHIC FINDINGS OF DYSGERMINOMA

• Ovoid, solid echogenic mass on the ovary
• May contain some cystic components

Yolk Sac Tumor (Endodermal Sinus Tumor)

CLINICAL FINDINGS OF YOLK SAC TUMOR

• Elevation in serum AFP

SONOGRAPHIC FINDINGS OF YOLK SAC TUMOR

• Homogeneous echogenic mass or complex mass
• Varying sonographic appearances

Endometrioid Tumor (Endometrioid Carcinoma)

CLINICAL FINDINGS OF ENDOMETRIOID TUMOR

• History of endometrial cancer or endometriosis

SONOGRAPHIC FINDINGS OF ENDOMETRIOID TUMOR

• Complex mass with solid components
• Cystic mass with papillary projections
• others
• Carcinoma
• Staging of Ovarian Carcinoma

Ovarian Torsion

CLINICAL FINDINGS OF OVARIAN TORSION

• Acute unilateral abdominal or pelvic pain
• Nausea and vomiting
• Slight leukocytosis

SONOGRAPHIC FINDINGS OF OVARIAN TORSION

• Enlarged ovary
• Enlarged ovary in the presence of multifollicular development
• Small peripherally located follicles on the enlarged ovary as a result of edema
• Lack of or diminished flow patterns compared with the nonaffected ovary
• “Whirlpool” sign

Excessive free flui

Hydrosalpinx

• Ovarian torsion. A. Sagittal image of right ovary (between calipers)
• showing enlargement (>5 cm), globular shape, and edema, all as a result of torsion. B.
• Sagittal view with color Doppler showing no flow in the torsed ovary (arrows).
• (Color images provided online.)
• Hydrosalpinx. Coronal image of a dilated right fallopian tube (between

arrows) filled with anechoic fluid. Note the folds (arrowheads) of the tortuous tube.

Pyosalpinx. Echogenic debris or pus is noted within this dilated and inflamed fallopian tube

MENOPAUSE

Menopause, or climacteric, is the cessation of menstruation with advanced age. The average age at which menopause occurs is 51, with a range in normal women between the ages of 45 and 55.

Endometrial Atrophy

In the postmenopausal patient, the endometrium often bleeds spontaneously secondary to atrophy

Endometrial Hyperplasia

Endometrial hyperplasia is a common cause of abnormal vaginal bleeding, not only in the postmenopausal female but also in the reproductive years.

• Endometrial atrophy.

Endometrial hyperplasia

CLINICAL FINDINGS OF ENDOMETRIAL HYPERPLASIA

• Abnormal uterine bleeding (any age)
• Polycystic ovary syndrome
• Obesity
• Tamoxifen therapy

SONOGRAPHIC FINDINGS OF ENDOMETRIAL HYPERPLASIA

• Thickened echogenic endometrium
• Small cystic spaces within the endometrium

Endometrial Carcinoma

CLINICAL FINDINGS OF ENDOMETRIAL CARCINOMA

• Postmenopausal bleeding
• Intermenstrual bleeding
• Enlarged uterus
• Elevation of CA-125

SONOGRAPHIC FINDINGS OF ENDOMETRIAL CARCINOMA

• Thickened endometrium
• Heterogeneous uterus
• Enlarged uterus with lobular contour
• Endometrial fluid
• Polypoid mass within the endometrium

Endometrial Polyps

CLINICAL FINDINGS OF ENDOMETRIAL POLYPS

• Can be asymptomatic
• Menometrorrhagia
• Intermenstrual bleeding
• Has been linked with infertility in reproductive-aged group

SONOGRAPHIC FINDINGS OF ENDOMETRIAL POLYPS

• Focal thickening of the endometrium
• Diffuse thickening of the endometrium

Endometrial polyp and saline infusion sonohysterography. A. A polyp is suspected in a patient with focal thickening of the endometrium (between calipers).

• B. Saline (S) infusion sonohysterography better depicts the evidence of an

endometrial polyp (arrow)

PELVIC INFLAMMATORY DISEASE

• complex adnexal masses

CLINICAL FINDINGS OF ACUTE PELVIC INFLAMMATORY DISEASE

• Possible history of a sexually transmitted disease (chlamydia or gonorrhea)
• Fever
• Chills
• Pelvic pain and/or tenderness
• Purulent vaginal discharge
• Vaginal bleeding or itchiness
• Dyspareunia
• Leukocytosis

SONOGRAPHIC FINDINGS OF ACUTE PELVIC INFLAMMATORY

DISEASE

• Thickened, irregular endometrium (endometritis)
• Ill-defined uterine borders
• Tubular structures representing dilated fallopian tubes containing echogenic material (pyosalpinx)
• Tubular structures representing dilated fallopian tubes containing simple_x0002_appearing, anechoic fluid (hydrosalpinx)
• Cul-de-sac fluid
• Multicystic and solid complex adnexal mass(es) (see “Tubo-ovarian Complex and Tubo-ovarian Abscess” section)

CLINICAL FINDINGS OF CHRONIC PELVIC INFLAMMATORY DISEASE

• Continual pelvic or abdominal pain
• Infertility (resulting from adhesions and scaring of the fallopian tubes)
• Possible palpable adnexal mass
• Irregular menses
• Purulent vaginal discharge
• Vaginitis and Cervicitis
• is the most common initial clinical presentation in the early stages
• of PID.
• Endometritis
• is the inflammation of the endometrium

CLINICAL FINDINGS OF ENDOMETRITIS

• History of recent abortion, postpartum, D&C, PID, surgery, or intrauterine device
• Pelvic tenderness
• Fever
• Leukocytosis

SONOGRAPHIC FINDINGS OF ENDOMETRITIS

• Thickened echogenic or irregular-appearing endometrium
• Endometrial fluid
• Ring-down artifact from gas or air within the endometrium

Pelvic Inflammatory Disease and the Fallopian Tubes

• Pyosalpinx. This dilated tube (between calipers), seen posterior to the
• urinary bladder (Bl), contains pus and has a thickened wall

CLINICAL FINDINGS OF SALPINGITIS

• Findings consistent with PID
• Pelvic tenderness
• Fever
• Leukocytosis

SONOGRAPHIC FINDINGS OF SALPINGITIS

• Distended fallopian tube filled with echogenic material (pus) or anechoic fluid
• Hyperemic flow within or around the affected fallopian tube depicted with color Doppler
• Nodular, thickened wall of the fallopian tube

Tubo-ovarian Complex and Tubo-ovarian Abscess

Tubo-ovarian complex. Longitudinal transabdominal image of the adnexa revealing a complex adnexal mass (arrow) composed of a dilated fallopian tube (arrowheads) and enlarged ovary (O) seen posterior to the bladder (BL) Tubo-ovarian abscess. Transvaginal image of a complex adnexal mass (arrows) with poorly defined borders and complex fluid.

CLINICAL FINDINGS OF TUBO-OVARIAN COMPLEX AND TUBOOVARIAN ABSCESS

• Findings consistent with PID

SONOGRAPHIC FINDINGS OF TUBO-OVARIAN COMPLEX

• Thickened, irregular endometrium
• Pyosalpinx or hydrosalpinx
• Cul-de-sac fluid
• Multicystic and solid complex adnexal mass(es)

SONOGRAPHIC FINDINGS OF TUBO-OVARIAN ABSCESS

• Thickened, irregular endometrium
• Pyosalpinx or hydrosalpinx
• Cul-de-sac fluid
• Multicystic and solid complex adnexal mass(es)
• Complete loss of borders of all adnexal
• structures, and the development of
• a conglomerated adnexal

(possibly bilateral) mass

CAUSES OF FEMALE INFERTILITY

Infertility is defined as the inability to conceive a child after 1 year of unprotected intercourse.

• endometriosis,
• polycystic ovarian syndrome,
• tubal causes,
• Asherman syndrome,
• uterine leiomyomas,
• Endometriosis
• is defined as functional, ectopic endometrial tissue located outside the uterus

CLINICAL FINDINGS OF ENDOMETRIOSIS

• Patient may be asymptomatic
• Pelvic pain
• Infertility
• Dysmenorrhea
• Menorrhagia
• Dyspareunia
• Painful bowel movements

SONOGRAPHIC FINDINGS OF AN ENDOMETRIOSIS

• Predominantly cystic mass with low-level internal echoes (may resemble a hemorrhagic cyst)
• Anechoic or complex mostly cystic mass with posterior enhancement and may contain a fluid–fluid level

POLYCYSTIC OVARY SYNDROME

CLINICAL FINDINGS OF POLYCYSTIC OVARY SYNDROME

• Stein–Leventhal syndrome (amenorrhea, hirsutism, and obesity)
• Infertility
• Oligomenorrhea
• Hyperandrogenism

SONOGRAPHIC FINDINGS OF POLYCYSTIC OVARY SYNDROME

• “String of pearls” sign or “necklace” sign describes the presence of many small cysts measuring along the periphery of the ovary
• Many small cysts scattered throughout the ovary
• Bilateral enlargement of the ovaries
• Increased stroma and increased stromal echogenicity
• One or both ovaries should contain 12 or more follicles that measure between 2 and 9 mm in diameter
• Ovarian volume greater than 10 mL
• Threshold of 25 small follicles can also be used
• Endometrioma. A. Fluid–fluid level in an endometrioma. Coronal scan
• of the left ovary revealing a cystic adnexal mass (arrows) containing a fluid–fluid
• level (arrowheads). B. Transvaginal image of a homogeneous mass containing low_x0002_

level echoes that was determined to be an endometrioma.

Tubal Causes of Infertility

hydrosalpinx is the accumulation of fluid within the fallopian tube.

Polycystic ovary. Longitudinal sonogram demonstrating an enlarged round ovary (between arrows) with multiple small follicles less than or equal to 8 mm in diameter located around the periphery of the ovary (string of pearls sign). The stroma (S) of the ovary also appears to have increased echogenicity.

Hysterosalpingography can be used to evaluate the patency of the fallopian tubes, as well as hysterosalpingosonography or hysterosalpingo contrast-sonography (Fig. 21-10).

Hysterosalpingography. The hysterosalpingography procedure is a radiographic procedure used to evaluate the patency of the fallopian tubes with contrast.

Asherman Syndrome and Infertility

CLINICAL FINDINGS OF ASHERMAN SYNDROME

• History of D&C, trauma, and uterine surgery
• Recurrent pregnancy loss
• Amenorrhea or hypomenorrhea

SONOGRAPHIC FINDINGS OF ASHERMAN SYNDROME

• Bright areas within the endometrium
• Sonohysterography findings include bright bands of tissue traversing the uterine
• cavity
• Uterine Leiomyomas and Infertility

CLINICAL FINDINGS OF A UTERINE LEIOMYOMA

• Pelvic pressure
• Menorrhagia
• Palpable abdominal mass
• Enlarged, bulky uterus (if multiple)
• Urinary frequency
• Dysuria
• Constipation
• Infertility

SONOGRAPHIC FINDINGS OF A UTERINE LEIOMYOMA

• Hypoechoic mass within the uterus
• Posterior shadowing from mass
• Degenerating fibroids may have calcifications or cystic components
• Multiple fibroids appear as an enlarged, irregular shaped, diffusely heterogeneous uterus

Ovarian Hyperstimulation Syndrome

CLINICAL FINDINGS OF OVARIAN HYPER STIMULATION SYNDROME

• Fertility treatment, including ovulation induction
• Electrolyte imbalance
• Oliguria
• Nausea
• Vomiting
• Abdominal distension
• Ovarian enlargement
• Ovarian hyperstimulation syndrome. Dramatically enlarged ovary

secondary to ovulation induction medication. Color image provided online

SONOGRAPHIC FINDINGS OF OVARIAN HYPERSTIMULATION

SYNDROME

• Cystic enlargement of the ovaries >5 cm
• Ascites
• Possible pleural effusion

FORMS OF CONTRACEPTION

• is a reversible form of contraception.

An IUD is placed in the uterine cavity and prevents implantation of the fertilized ovum.

A small plastic T-shaped IUD, distorts the uterine cavity and also releases small amounts of progestin to impede implantation and produce lighter menstrual bleeding.

The ParaGard is another T-shaped IUD, although it utilizes copper in its composition to inhibit sperm transport, or to prevent fertilization or transplantation.

• Intrauterine devices create posterior shadowing and have been described

as producing an “entrance and exit echo” on a sonogram Intrauterine device. Transvaginal image of an intrauterine device in sagittal (A) and coronal (B).

Transabdominal image revealing an intrauterine device (small arrows) adjacent to anIintrauterine gestational sac (long arrow) containing an embryo (arrowhead).(c) C

• A

B

Coronal Uterine Anatomy and Imaging

The pill is a popular form of birth control, and it is highly successful if the manufacturer guidelines are strictly followed.

• Birth control pills produce an anovulatory cycle.

Other forms of contraception include the Essure device,and tubal sterilization.

The Essure device is a permanent form of birth control that uses small coils placed into the proximal isthmic segment of the fallopian tubes.

NYAMAGANA HOSPITAL

NO,223

• Name: ABC

Date: 27 April, 2024

• Sex; female
• Age;23 years

PELVIC ULTRASOUND REPORTY

• INDICATION:Lower abdominal pain
• TECHNIQUE:The patent was put supine and griped,the transabdominal scan was done

FINDINGINS

Antiverted non gravid uterus appears normal in size,shape and echopatten.it measures (8x5xa)cm,no myometrial masses or lesion seen The endometrium appears normal in thickness.it measures (0.5cm in anteroposterior dimasion.No fluid collection seen within the it.

Both ovaries appears normal in size ,shape and echo pattern.They measures (3×2)cm and (3×3)cm from both right and left respectively The cervix appears normal and devoid of mass No free fluid collection within the pouch of duoglus seen

CONCLUSION.

• Normal scan

RADIOGRAPHER:CLEVER MLAWA. SIGNATURE:C.mlawa.

REFFERENCE

EXAMINATION REVIEW FOR ULTRASOUND 2 EDITION

SHORT HANDBOOK FOR ULTRASOUND BY Abdullah Noor Wazir