Imaging of the Uterus

7/30/2019 Imaging of the Uterus

1/40

Imaging

of the

Uterus


2/40

Sonographic Technique

A. Transabdominal Sonogram:

1. Performed with a distended bladder

2. Transducer is 3.5 to 5.0 Mhz

3. Done in sagittal & transverse planes

B. Transvaginal Sonogram:1. Performed with an empty bladder

2. Transducer is 5.0 to 7.5 Mhz

3. Done in sagittal & coronal planes


3/40

Higher frequency = better resolution

possible without filling bladder

in obese patients

in evaluating retroverted uterus

better distinction of adnexae & bowels greater detail of internal characteristics

of pelvic masses

ADVANTAGES OF TVS


4/40

SYSTEMATIC EXAMINATION OF THEPELVIS

1. Locate the uterus

2. Examine the endometrium 3. Visualize the cervix

4. Image the adnexae

5. Examine the posterior cul-de-sac


5/40

SONOGRAPHIC ANATOMY

Lies in the true pelvis between the urinarybladder and rectosigmoid colon

Variable uterine position: Flexion

Version

Size and Shape varies:

1. Infantile or Prepubertal:

L = 2.0 - 3.3 cms

AP=0.5 - 1.0 cms.

Tubular or inverse pear shape


6/40

2. Neonatal: L = plus 0.6 - 0.9 of infantile

AP = plus 0.7 - 0.8 of infantile

3. Postpubertal/ Adult:

maximum dimensions : L= 8 cmsW= 5 cms

AP= 4 cms


7/40

4. Multiparous: increase in size bymore than 1 cm in each adult

dimension 5. Postmenopausal: uterus atrophies,

most rapid after 10 yr

Over 65 y/o : L = 3.5 - 6.5 cms.

AP= 1.2 - 1.8 cms.


8/40

NORMAL MYOMETRIUM

1. Inner layer

2. Intermediatelayer

3. Outer layer


9/40

NORMAL ENDOMETRIUM

1. Superficial

Functional layer

2. Deep Basal Layer


10/40

PREMENOPAUSAL ENDOMETRIUM

Menstrual Phase thin echogenic line

Proliferative Phase hypoechoic thickening

4 to 8 mm

Secretory Phase hyperechoic thickening7 to 14 mm


11/40

MENSTRUAL PHASE


12/40

PROLIFERATIVE PHASE


13/40

SECRETORY PHASE


14/40


15/40

CONGENITAL UTERINEMALFORMATIONS

Due to arrested development of

Mullerian ducts

Failure of fusion of Mullerian ducts

Failure of resorption of median

septum


16/40


17/40


18/40

Bicornuate Uterus - Gravid


19/40

ABNORMALITIES OF THEMYOMETRIUM

1. Leiomyoma

2. Lipoleiomyoma

3. Leiomyosarcoma

4. Adenomyosis

5. Arteriovenous Malformations


20/40

LEIOMYOMA CLASSIFICATION

1. Intramural : confined to themyometrium

2. Submucosal : projecting into theuterine cavity

3. Subserosal : projecting from the

peritoneal surface


21/40



22/40


1. Intramural Myoma


23/40


2. Submucous Myoma


24/40


3. Subserous Myoma


25/40

LIPOLEIOMYOMA


26/40

LEIOMYOSARCOMA


27/40

ADENOMYOSIS


28/40

CAUSES OF ENDOMETRIAL THICKENING

Early intrauterinepregnancy

Incompleteabortion

Ectopic pregnancy

Retained products

Trophoblasticdisease

Endometritis

Adhesions

Hyperplasia

Polyps

Carcinoma


29/40

ABNORMALITIES OF THE ENDOMETRIUM

1. Postmenopausal endometrium

2. Hydrometrocolpos & Hematometrocolpos

3. Endometrial hyperplasia

4. Endometrial hypertrophy

5. Endometrial polyps

6. Endometrial carcinoma 7. Endometritis

8. Endometrial Adhesions (Synechiae)

9. Intrauterine Devices


30/40


RECOMMENDATIONS FOR POSTMENOPAUSAL WOMEN

(Endometrial Thickness)=/< 4 mm 5-8 mm >8 mm

Bleeding No Bleeding No Sequencial All Other

Bleeding Bleeding Hormones Hormone

Regimens

No Biopsy Normal Biopsy Probably Rescan Early Biopsy

(probably normal or late in

atrophy) no biopsy cycle

if still >8 mm,

then biopsy


31/40


Hematometrocolpos


32/40


Endometrial Hyperplasia



33/40


Endometrial Polyps



34/40


Endometrial Carcinoma



35/40


Endometritis



36/40


Intrauterine Device


37/40

ABNORMALITIES OF THE CERVIX

1. Nabothian cysts

2. Cervical polyps

3. Cervical Stenosis

4. Cervical carcinoma


38/40


Nabothian cysts


39/40


Cervical Polyp


40/40

T h a n k

y o u ! ! !

Imaging of the Uterus

Documents

Transcript of Imaging of the Uterus