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42 Cards in this Set
- Front
- Back
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Enlarged ovary
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> 12 cc
Ovarian Torsion / Intermittent torsion PCOS - clinical syndrome amennorhea or irregular menses, obesity, hirsutism - enlarged ovaries - "string of pearls" peripherally arrayed follicles Ovarian hyperstimulation syndrome - due to exogenous hormones for fertility treatment or endogenous hormones (neoplasm?) + ascites + pleural effusions |
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Adenomyosis
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Endometriosis of the uterus
Junctional zone > 12 mm Myometrial cysts Asymmetric enlargement of anterior and posterior uterine walls |
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Endometrial carcinoma
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MC gynecologic cancer
Suspect in post-menopausal woman with vaginal bleeding - Endometrial stripe > 5 mm postmenopausal or > 8 mm postmenopausal on estrogen |
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GTD
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elevated bHCG
vaginal bleeding thickened stripe uterine size greater than dates ovarian theca lutein cysts preeclampsia hyperemesis gravidarum |
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Uterine abnormalities
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Always check for asoociated renal ectopia or agenesis
Bicornuate - two horns - one or two cervixes (uni- or bicollis) - fundus is dimpled > 1 cm - separate endometrial canals - may be a/w fusion abnormailies with a rudimentary horn or cornual hypoplasia - tx metroplasty Didelphis - 2 horns, 2 cervixes, 2 vaginas - incidental finding Unicornuate - one horn Septate - thin fibrous membrane separating endometrial canal - a/w infertility due to failed implantations on relatively avascular septum - fundus normal, straight, or dimpled < 1 cm - tx transvaginal septal resection Arcuate - normal variant - fundus dimpled < 1 cm |
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Starry sky liver
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ACUTE HEPATITIS
Hepatic congestion Biliary / PV air Diffuse infiltrating neoplasm |
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Ovarian neoplasms
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90% epithelial
- serous cystadenoma / carcinoma - mucinous cystadenoma / carcinoma 10% - germ cell - sex cord - mets |
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US threshold for OB detection / failed 1st trimester px
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Should detect Yolk sac with mean sac diameter (MSD):
> 8 mm (TV) > 20 mm (TA) Should detect FETAL POLE with means sac diameter (MSD): > 18 (TV) > 25 (TA) Should detect FETAL CARDIAC ACTIVITY if fetal pole: > 5 mm |
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Hyperechoic subchorionic structure
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Subchorionic hemorrhage
Succenturiate lobe (accessory placenta) IUP with concommitant molar pregnancy Fibroid |
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Fetal ventriculomegaly
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Lateral ventricels > 10 mm
Spina bifida Dandy Walker Chiari Aqueductal stenosis Encephalocele |
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Midline fetal intracranial cystic structure
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Arachnoid cyst
Ch |
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Diffuse GB wall thickening
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Acute chole
Chronic chole Venous congestion Hypoprotienemia PV HTN with GB mural collaterals Hepatitis/Pacreatitis/Duodenitis |
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Multiple splenic hypoechoic lesions
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Mets (melanoma, lung, breast, colon)
Candidiasis Lymphoma Histo TB PJP Sarcoid |
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Testicular cysts
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Tunica albuginea cysts
- peripheral - < 5 mm - palpable Tubular ectasia of the rete testes - mediastinal location - +/- spermatocele Testicular cyst - intraparenchymal - not palpable |
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Testiclular neoplasm
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GCT
Seminoma - MC - homogeneous - hypoechoic Non-seminomatous Mixed GCT - coarse Ca++ - cystic change Embryonal cell Teratoma Choricarcinoma Sex cord tumor Lymphoma - older men - hypoechoic - homogeneous - increased vascularity Mets Epidermoid - onion skin - enucleation Sertoli-Leydig Cell - benign - surgery as malignancy can't be excluded |
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Fetal sacral mass
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Sacrococcygeal teratoma
- internal, external, or both - solid, cystic or mixed - may cause hydrops Myelomeningocele - may be anterior (internal) - Chiari II Rhabdomyosarcoma |
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Increased Nuchal translucency
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Measured at 11-14 weeks
Nl < 2.8 mm Increased in: Trisomy 21, 18, 13 Turner syndrome Edema |
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"banana" sign
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Banana shaped posterior fossa, cerebellum on axial fetal US
Chiari II Dandy-Walker Joubert |
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Fetal lung mass
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CPAM
- >80% of fetal lung masses Sequestration Intralobar - invested by shared pleura - pulmonary venous drainage Extralobar - invested by separate pleura - systemic drainage CLO CDH |
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TWINS
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Di/Di
- dizygotic or monozygotic - separate or fused placentae - chorion/amnion > 2 mm thickness - "twin peak" sign of placental tissue extending between the chorionic leaves Mono/di - monozygotic - risk of TTTS, preterm delivery, mortality, IUGR Mono/Mono - monozygotic - risk of TTTS, cord entanglement, preterm delivery, IUGR, mortality |
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Twin-twin transfusion syndrome
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> 20% discrepancy of estimated fetal weight in monochorionic twins
Due to vascular shunting in placenta Underperfused twin may develop IUGR and "stuck twin" DDx: normal variation |
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Asymmetric twin size
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Nl variation
TTTS Fetal demise |
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Fetal US: hydronephrosis and megacystis
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Posterior urethral valves
- male Prune belly - deficient abdominal wall musculature - hydro - megaureter - megacystis - cryptorchidism Megacystitis-microcolon intestinal hypoperistalsis syndrome |
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Umbilical cord abnormalities/lesions
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2 vessel cord
a/w - increased incidence of congenital abnormalities - IUGR Cord hematoma - iatrogenic - may compress vessels resulting in fetal demise Wharton Jelly cyst - cyst in cord Cord hemangioma - may compress vessels Cord varix - aneurysm of vein - may thrombose |
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GTD
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Complete Hyatidiform Mole (CHM)
- Paternal origin - 46 XX > 46 XY - cystic intrauterine mass - "Bunch of grapes" - elevated bHCG - BL theca lutein cysts (bHCG stimulation of large ovarian septated cysts) - marked increased vascularity with low resistance flow - may progress to invasive mole or choriocarcinoma Partial mole - triploidy - diandric sperm or 2 sperm fertilize a normal egg DDx: Placental hydropic degeneration - after failed pregnancy Placental sonolucenies (pseudomole) - "swiss cheese" - often with maternal comorbidities RPOC |
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Echogenic intracardiac focus
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Incidental finding represents ca++ in papillary muscle
IF IN px at high risk (i.e. advanced maternal age) - then a marker for increased risk of Downs and Trisomy 13 DDx: Rhabdomyoma - TS - may regress Cardiac fibroma - Beckwith-Weidemann Cardiac teratoma - rare - usually large - usually with pericardial effusions Cardiac hemangioma - usually RA - a/w pericardial effusions |
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Fetal ventriculomegaly
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Ventriculomegaly
= lateral ventricle > 10 mm Ventriculomegaly NOS Aqueductal stenosis or web Chiari 2 ACC D-W |
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Truncus arteriosus
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A/W
Right arch DiGeorge syndrome |
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Fetal cystic neck mass
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Lymphatic malformation
Cystic teratoma Myelomeningocele |
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Fetal US: BL enlarged kidneys with loss of corticomedullary differentiation
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ARPKD
Trisomy 13 - Patau - enlarged echogenic kidneys. similar to ARPKD - + cardiac defects, facial clefts, holoprosencephaly, microcephaly, omphalocele, polydactyly Meckel-Gruber - lethal - kidneys similar to ARPKD with replacement of parenchyma by microscopic cysts - occipital encephalocele - polydactyly |
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Oligohydramnios
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AFI < 5 cm
Maximum pocket of fluid 1-2 cm Fetal crowding Lack of urine production in 2-3 trimesters Renal problems - agenesis - MCDK - ARPKD Outlet obstruction PROM IUGR - decreased perfusion of placenta - increased ratio of flow to brain - decreased flow to kidneys -> decreased UOP |
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Polyhydramnios
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Excessive amniotic fluid
> 1500 cc AFI > 25 Vertical pocket > 8 cm Decreased fetal swallowing Increased fetal urination DDx: Esophageal atresia Duodenal atresia SB atresia CNS / neural tube defects Maternal DM Idiopathic Fetal hydrops |
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Fetal hydrops
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Abnormal accumulation of fluid in 2 or more fetal cavities:
Placental enlargement Body wall edema Pericardial effusions Pleural effusions Ascites Usually + polyhydramnios Due to immune or non-immune: Maternal auto-antibodies or CV abnormalities Infection (parvovirus B19, CMV, syphillis) chromosomal abnormalities (trisomy 21, 13, 18, Turner) |
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Placenta accreta / increta / percreta
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Accreta
- abnormal adherence of placenta to myometrium Increta - invasion of myometrium Percreta - invasion through myometrium Findings: placental lacunae turblulent flow within lacunae myometrial thinning overlying placental attachment increased vascularity between serosa and bladder Risks - C-section or prior uterine surgery |
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Placental abnormalities
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Marginal insertion of cord
- controversial a/w IUGR Previa a/w: - prior c section - smoking - cocaine - increased age Vasa previa - vilamentous insertion of cord with cord passing though membranes prior to inserting at placenta - if anterior to cervical os, may lead to hemorrhage at time of ROM Circumvallate placenta: - upturning of placental margin - a/w abruption, PROM, IUGR, preterm labor |
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Omphalocele
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Midline abdominal defect
cord at apex covered by amnion and peritoneal membranes A/W: cardiac abnormalities chromosomal abnormalities atresias malrotation 10% mortality, higher if seen with other anomalies |
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Limb-body wall complex
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Omphalocele
Craniofacial defects Limb reductions Spinal defects |
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Pentology of Cantrell
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Omphalocele
Ectopia cordis Diaphragmatic defect Pericardial defect CV malformation |
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Microlithiasis
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Controversial a/w neoplasm
Previously Annual US Alternative q3month self exams yearly physical exam |
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Epididymal Lesions
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Inflammatory
Adenomatoid - MC tumor Mets |
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Endometrioma
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Homogeneous low level echoes
High T1 Shading on T2W 1% risk of malignant transformation - Endometroid - Clear cell CA - size > 9 cm Annual F/U if small or typical |
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US of cystic ovarian masses
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PREMENOPAUSAL
Simple < 3 cm -> do nothing Simple 3-5 cm -> describe as benign Simple 5-7 cm > probably benign (annual FU Simple > 7 -> MRI Gyn consult Hemorrhagic < 3 cm -> do nothing Hemorrhagic 3-5 cm -> describe as benign Hemorrhagic > 5 cm -> probably benign (annual FU) POSTMENOPAUSAL Simple < 1 cm -> describe as benign Simple 1-7 cm > probably benign (annual FU) Simple > 7 -> MRI Gyn consult Hemorrhagic < 3 cm -> do nothing Hemorrhagic 3-5 cm -> describe as benign Hemorrhagic > 5 cm -> probably benign (annual FU) |
