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99 Cards in this Set
- Front
- Back
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3 most common sono findings that indicate abnormality
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1. Uterus enlargement
2. Contour irregularity 3. Thickened endometrium |
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What is associated with uterine enlargement at reproductive age?
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pregnancy, fibroids
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What is assoc. w/ uterine enlargement post menopause?
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fibroids, endometrial pathology
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What is assoc. w/ uterine enlargement in pediatric patients?
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Hormonal stimulation
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What is contour irregularity assoc. with or due to?
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Fibroids, or developmental abnormalities (bicornuate)
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What is endo. thickening associated with?
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Hyperplasia, carcinoma...sonohysterography is best imaging modality!
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What is Gestational Trophoblastic disease?
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A group of diseases that develop from trophoblastic cells
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4 forms of GTD
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1) Molar Pregnancy
2)Invasive mole 3) PSTT 4) Choriocarcinoma |
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First form of GTD (molar pregnancy) has what 3 subtypes?
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1) Hydatidiform (complete mole)
2) Incomplete/partial 3) Co-existent |
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Which type of molar pregnancy is associated with abnormal fertilization of empty ovum?
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hydatitidiform
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Which form of GTD is associated with 20% progressing to PTN
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Hydatidiform
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This type is associated with chorionic villi persisting and growing
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hydat.
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Who is most prone to getting a hydat. mole?
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>46, <14, people with hx of molar pregnancy, asians
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What is the sono appearnance of a hydat. mole in the 1st trimester?
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blighted ovum, may resemble a hematoma, or a necrotic fibroid
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sono appearance of hydat. mole in 2nd tri?
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resembles a bunch of grapes..cysts develop and inc. in size
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which other appearances do hydat. moles have?
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snowstorm appearance, theca lutein cysts (ovary)
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complications of molar pregnancy
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progresses to PTN, hyperthyroidism, anemia/hemorrhage, pulmonary edema, rupture, hemorrhage or torsion of theca lutein cyts
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Partial (incomplete mole) 4 things about it
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1.focal hyperplasia of tropho. cells with identifiable fetus, amnion, fetal parts
2. chromosomal triploid (fertilized by 2 sperm, or 1 diploid) 3. Pregnancy may be viable 4. Little malignant potential (5% to PTN) |
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Differential of Incomplete mole
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Missed AB
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In this type of molar pregnancy, there is an enlarged placenta and clinical signs are more mild due to less trophoblastic proliferation
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Incomplete mole
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What does a coexistent mole result from?
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dizygotic twin pregnancy
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A coexistent mole contains what 3 things has what?
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mole, placenta, fetus
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What is the prognosis for a coexistent mole?
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poor prognosis, rare, risk for pers. GTD
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coexistent moles have what benign or malignant potential?
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malignant
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How do you treat a molar pregnancy?
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D & C, Beta HCG monitoring..weekly till its 3 weeks clear, then monthly for 6 months, birth control pills
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3 categories of PTN or persistent trophoblastic neoplasia
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invasive mole, Choriocarcinoma, PSTT
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What does an invasive mole invade?
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myometrium, blood vessels, possibly peritoneum
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What is the most common form of PTN, which is also benign?
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invasive mole
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When beta HCG levels do not drop after HDM evac, what should you expect?
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Invasive mole
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Sono appearance of invasive mole
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focial irregular anechoic and echogenic areas in myometrium (hemorrhagic necrosis), heterogeneous and enlarged
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Which type of PTN is highly malignant and metastatic?
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Choriocarcinoma
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Percentages for choriocarcinoma
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>50% follow HDM
22% normal pregnancy 25% follow abortion 3% follow ectopic |
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What is the clinical picture of choriocarcinoma? (5 things)
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1. history of HDM evac
2. Persistent vaginal bleeding 3. Dyspnea 4. Persistently elevated HCG 5. Persistent theca lutein cysts |
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Where does choriocarcinoma spread?
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lungs, liver, brain
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What does Doppler show with Choriocarc?
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hypervascularity
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What is the rarest and most fatal form of GTD?
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PSTT
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What type of pregnancy does PSTT follow?
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any type
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Where does PSTT spread?
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lllppb
-lungs, liver, lymph nodes, placental, peritoneum, brain |
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what is PSTT resistant to?
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CHEMO
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Treatments of GTD
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CXR, CT, U.S., D&C, beta HCG monitoring, Chemo
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What are uterine fibroids?
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benign smooth muscle and fibrous tissue tumors arising from myometrium
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What is the most common pelvic mass and cause of uterine enlargement?
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fibroids
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What race is most common to get fibroids?
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African Americans
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up to 40% of women can get
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fibroids
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fibroids are sensitive to what?
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estrogen
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fibroids increase in size with pregnancy and...
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unopposed estrogen, HRT, Tamoxifen
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Fibroids regress with...
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menopause
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symptoms of fibroids
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asymptomatic, pelvic pain/fullness, increase ab. girth, enlarged ut, back pain, abnormal bleeding (irreg. spotting, menorrhagia), frequent urination, rectal pressure
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4 places uterine fibroids can occur
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1. intramural (within myometrium)
2. Subseroseal- benath serosa-may be pedunculated, sep. from ut. 3. submucosal- below endo- may distort endo 4. cervical-rare and may obstruct childbirth |
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most common site of fibroids
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intramural
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Sono appearance of fibroids
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contour irregularity, enlargement, distortion of endo, attenuation/shadowing, single/multiple/diffuse, hypo or iso to myo, hetero.
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What happens to fibroids during pregnancy..?
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increase in size, and decrease in echogenicity (cystic degeneration)
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Why are large fibroids significant during pregnancy?
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Compete with placenta for uterine blood vessels, & if fibroids "win," fetus may be growth restricted
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what is Leiomyosarcoma?
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malig. form of leiomyoma, can arise from existing fibroid, rare, can't be diff. from a benign one
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3 treatments for fibroids
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1. Monitoring growth
2. myomectomy, hysterectomy 3. embolization (get rid of blood vessels supplying myoma) |
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Endo measurements for days 1-4, 6-13, 14-28and for post meno.
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1-4= <4
6-13= 4-12 mm 14-28 = up to 15 mm post meno= <4-5 w/ no HRT, up to 8 w/ |
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What causes endo thickening?
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Early IUP, ectopic, incomplete AB, retained POC, GTD, endometritis, polyps, hyperplasia, carcinoma
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endo pathology is best evaluated with what?
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transvag and sonohyst.
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What are endo polyps?
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localized overgrowths of endometrial glands and stroma
-asymptomatic or irregular bleeding |
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Sono of polyps
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-broad based/pedunculated
-discrete echo mass -diffuse/non-specific endo thickening |
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What is endometrial hyperplasia?
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Benign overgrowth of endometrium
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What usually causes endo hyperplasia?
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effects of unopposed estrogen w/o regulating effects of progesterone
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Endo hyperplasia causes
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-hrt
-polycystic ov. disease -anovulation -gran. cell tumors -obesity -tamoxifen use |
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Most common cause of postmenopausal bleeding
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endometrial hyperplasia
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how is the diagnosis for endo hyperplasia made?
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biopsy/curettage
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Treatments for endo hyperplasia
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curettage, hormonal therapy, hysterectomy
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Most common GYN malignancy in us
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endometrial carcinoma
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incidence of endo carc. increases with use of what
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HRT, tamoxifen
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Risk factors for endo carcinoma
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Obesity
chronic anovulation HRT/tamoxifen early menarche/late menopause |
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Endo carcinoma appears more ______ & ________ than benign hyperplasia
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irregular and thicker
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Reason for vag. fluid during reproductive age
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blood due to menstruation
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Reason for vag. fluid during prepubertal
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vag/cx obx, vag septum
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Reason for vag fluid postmenopausal
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malignancy, cervical stenosis
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vaginal canal=
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colpos
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uterine cavity=
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metra
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blood=
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hemato
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mucosal secretions=
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hydro
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pus/infection=
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pyo
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Where are Gartner's duct cysts seen?
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Lateral aspect of vagina
w/I broad ligament Adnexa (adj. to ovary) |
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What are nabothian cysts (5 things)
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benign cysts of cx
obx endocervical cysts no clinical significance single/multiple internal echoes |
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What 3 things do IUDs do?
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1.Stimulate low-grade inflammatory responses in endo (toxic to sperm
2. Some release hormones prog=alter endo levonorgestrol= prevents ovulation 3. Alters phase of endo. |
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IUD contraindications
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pregnancy
PID myomas abnormal ut. bleeding cancer congenital ut. abnormalities post-partum Hx ectopic pregnancy |
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3 things US does in evaluating IUDS
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1. locate lost ones
expelled detached string improper loc. 2. uterine perforation 3. evaluate pelvis for PID/abscess |
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Sono appearance of IUDs
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Type specific echogenic pattern
high-amp linear echoes w/in cavity acoustic shadowing body/fundus |
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what is uterine adenomyosis?
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endo growing in myo (internal endraphically
ometriosis of myo) -difficult to diagnose sonog. -diffuse enlargement w/normal contour -heterogeneous echotexture -focal or like a fibroid occasionally -pain, dysmenorrhea, menorrhagia |
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what is 2nd to endo cancer in incidence?
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cervical cancer
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what is the most common type of cervical cancer?
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squamous cell carcinoma
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how is diagnosis of cx cancer made
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pap smear
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cx cancer rarely presents as a ____
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solid mass
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what might you also visualize with cx cancer?
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hydro or hematometra secondary to cx obx
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What is DES syndrome?
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drug given from 40's-70s for treatment of a threatened abortion
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What did DES affect?
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genital tract development
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2 things common with DES recipients (baby in utero that is grown now)
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T-shaped uterus, poor pregnancy outcomes as an adult
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3 things that happen post hysterectomy
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1. vaginal cuff
2. ovaries in cul-de-sac 3. bowel loops fill space that ut occupied |
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What happens postpartum?
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ut decreases 2-3 mos following delivery, fluid/blood in cavity, thin endo, abnormal bleeding
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bladder flap hematoma
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following C-section..hemorrhage at incision site..fluid between bladder and ut.
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Pediatric pelvic sonography for Amenorrhea
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abnormal hormone levels
trans vag septum cx stenosis |
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pediatric pelvic sonography for ab genital tract dev.
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ambiguous ext. genitalia
turner's syndrome |
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precocious puberty
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sec. sex char. dev. before age 8 or menstruation before 10
-evaluate ov./adrenals -hormone prod. tumor (gran/theca cell or teratoma) |
