Diagnostic Ultrasound - Abdomen and Pelvis
Abnormal Endometrium ○ Multiple effects include – Polyps – Endometrial hyperplasia – Reactivation of foci of adenomyosis – Cystic endometrial atrophy with subendometrial cysts – Endometrial carcinoma □ Endometrial cancer in patients taking tamoxifen is frequently in endometrial polyps Helpful Clues for Rare Diagnoses • Endometritis ○ In postpartum patient, painful enlarged uterus ○ In nonpregnant patient, associated with pelvic inflammatory disease ○ Elevated white blood cell count ○ Thick, heterogeneous endometrial contents ± gas in septic endometritis • Unopposed Estrogen Use ○ Estrogen use without progesterone → endometrial polyps, hyperplasia, and carcinoma • Polycystic Ovary Syndrome ○ Enlarged ovaries with multiple, small, peripheral follicles ○ Central stroma may be echogenic but not a necessary component for diagnosis ○ No dominant follicle ○ Diffuse endometrial thickening due to prolonged proliferative phase or endometrial hyperplasia Other Essential Information • Transvaginal scanning is best for evaluation of endometrium ○ Saline infused hysterosonography helpful to differentiate focal lesions from diffuse thickening ○ Diffuse thickening can be sampled with blind biopsy ○ Focal mass best assessed with hysteroscopic biopsy • In some patients, orientation of endometrial cavity is such that transabdominal scan allows for better insonation and evaluation of endometrium • Additionally fibroids or very large uteri may preclude assessment using transvaginal probes • In uterine duplication anomalies, each endometrium must be separately evaluated Alternative Differential Approaches • Solid or complex ovarian lesion in association with endometrial lesion ○ Estrogenic effect from granulosa cell tumor may produce endometrial hyperplasia or carcinoma ○ Estrogen secretion from thecoma → endometrial lesions ○ Synchronous ovarian and endometrial carcinoma ○ Endometrioid ovarian carcinoma resembles endometrial carcinoma, associated with endometrial hyperplasia or carcinoma ○ Metastatic disease to ovaries from endometrial carcinoma SELECTED REFERENCES 1. Van den Bosch T et al: Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women. Facts Views Vis Obgyn. 7(1):17-24, 2015 2. Langer JE et al: Imaging of the female pelvis through the life cycle. Radiographics. 32(6):1575-97, 2012 3. Sakhel K et al: Sonography of adenomyosis. J Ultrasound Med. 31(5):805-8, 2012 4. Sofoudis C et al: Endometrial stromal sarcoma in a 29-year-old patient. Case report and review of the literature. Eur J Gynaecol Oncol. 33(3):328-30, 2012 5. Allison SJ et al: saline-infused sonohysterography: tips for achieving greater success. Radiographics. 31(7):1991-2004, 2011 6. Bennett GL et al: ACR appropriateness criteria(®) on abnormal vaginal bleeding. J Am Coll Radiol. 8(7):460-8, 2011 7. Salim S et al: Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 18(5):569-81, 2011 Differential Diagnoses: Female Pelvis Secretory Phase Endometrium Secretory Phase Endometrium (Left) Longitudinal US in a patient on day 24 of her menstrual cycle shows secretory phase endometrium ſt. The coapted walls of the cavity remain partially visible as a thin echogenic line . (Right) Longitudinal US in a patient late in her menstrual phase shows a thickened, slightly hyperechoic endometrium ſt consistent with the secretory phase. 1049
Abnormal Endometrium Differential Diagnoses: Female Pelvis (Left) The CT appearance of the endometrium is nonspecific. Low density was thought to represent fluid within an expanded endometrial cavity ; subsequent ultrasound confirmed normal secretory phase endometrium. (Right) US in the same patient shows a thickened echogenic endometrial complex ſt consistent with secretory phase endometrium, which corresponds to the hypodensity on the CT scan. There is no fluid present. Secretory Phase Endometrium Secretory Phase Endometrium (Left) Longitudinal US shows nonspecific endometrial thickening ſt in a patient with irregular vaginal bleeding. (Right) US obtained during saline infusion sonohysterography in the same patient shows distention of the endometrial cavity without focal lesions. Slight lobularity of the endometrial lining is a normal finding ("endometrial wrinkles"). Secretory Phase Endometrium Secretory Phase Endometrium (Left) Transverse color Doppler US in a patient status post recent medical abortion demonstrates a thickened endometrium ſt with vascular flow st, consistent with retained products of conception. (Right) Pulsed Doppler US in the same patient shows low-resistance flow, typical of but not specific for retained products of conception. Retained Products of Conception Retained Products of Conception 1050
- Page 1020 and 1021: PART III SECTION 9 Bowel Bowel Wall
- Page 1022 and 1023: Bowel Wall Thickening - Distal ileu
- Page 1024 and 1025: Bowel Wall Thickening Crohn Disease
- Page 1026 and 1027: Bowel Wall Thickening Clostridium D
- Page 1028 and 1029: PART III SECTION 10 Scrotum 1008
- Page 1030 and 1031: Diffuse Testicular Enlargement Test
- Page 1032 and 1033: Decreased Testicular Size Testicula
- Page 1034 and 1035: Testicular Calcifications Sertoli C
- Page 1036 and 1037: Focal Testicular Mass - Most common
- Page 1038 and 1039: Focal Testicular Mass Testicular Ly
- Page 1040 and 1041: Focal Extratesticular Mass - 3-50 m
- Page 1042 and 1043: Focal Extratesticular Mass Inguinal
- Page 1044 and 1045: Focal Extratesticular Mass Liposarc
- Page 1046 and 1047: Extratesticular Cystic Mass Varicoc
- Page 1048 and 1049: PART III SECTION 11 Female Pelvis
- Page 1050 and 1051: Cystic Adnexal Mass □ Hemorrhagic
- Page 1052 and 1053: Cystic Adnexal Mass Dermoid (Mature
- Page 1054 and 1055: Solid Adnexal Mass - May masquerade
- Page 1056 and 1057: Solid Adnexal Mass Fibrothecoma Hem
- Page 1058 and 1059: Extraovarian Adnexal Mass Helpful C
- Page 1060 and 1061: Extraovarian Adnexal Mass Paraovari
- Page 1062 and 1063: Extraovarian Adnexal Mass Lymph Nod
- Page 1064 and 1065: Enlarged Ovary - Often bilateral (5
- Page 1066 and 1067: Enlarged Ovary Theca Lutein Cysts T
- Page 1068 and 1069: Enlarged Uterus Leiomyoma Adenomyos
- Page 1072 and 1073: Abnormal Endometrium Pregnancy and
- Page 1074 and 1075: Abnormal Endometrium Tamoxifen-Indu
- Page 1076 and 1077: INDEX A Abdominal aorta, 34, 40, 42
- Page 1078 and 1079: INDEX - myelolipoma vs., 590 - stag
- Page 1080 and 1081: INDEX Biliary cyst. See Choledochal
- Page 1082 and 1083: INDEX Caroli disease, 204-207 - bil
- Page 1084 and 1085: INDEX - solid renal mass vs., 968 -
- Page 1086 and 1087: INDEX diagnostic checklist, 839 dif
- Page 1088 and 1089: INDEX Efferent ductules, 130 Ejacul
- Page 1090 and 1091: INDEX Focal myometrial contraction
- Page 1092 and 1093: INDEX - hydrocele vs., 715 - sperma
- Page 1094 and 1095: INDEX Hepatocellular carcinoma (HCC
- Page 1096 and 1097: INDEX Inflammatory pseudotumor, sol
- Page 1098 and 1099: INDEX - focal extratesticular mass
- Page 1100 and 1101: INDEX irregular hepatic surface vs.
- Page 1102 and 1103: INDEX Normal postpartum, enlarged u
- Page 1104 and 1105: INDEX Pararenal fat, posterior, 64
- Page 1106 and 1107: INDEX - inflammatory, gallbladder c
- Page 1108 and 1109: INDEX Pyelogenic cyst - dilated ren
- Page 1110 and 1111: INDEX Renal infection - renal lymph
- Page 1112 and 1113: INDEX - macrocystic variant, mucino
- Page 1114 and 1115: INDEX - right, 92 lesser sac, 93 Su
- Page 1116 and 1117: INDEX Tunica albuginea cyst - calci
- Page 1118: INDEX X Xanthogranulomatous cholecy
Abnormal Endometrium<br />
Differential Diagnoses: Female <strong>Pelvis</strong><br />
(Left) The CT appearance of<br />
the endometrium is<br />
nonspecific. Low density was<br />
thought to represent fluid<br />
within an exp<strong>and</strong>ed<br />
endometrial cavity ;<br />
subsequent ultrasound<br />
confirmed normal secretory<br />
phase endometrium. (Right)<br />
US in the same patient shows<br />
a thickened echogenic<br />
endometrial complex ſt<br />
consistent with secretory<br />
phase endometrium, which<br />
corresponds to the<br />
hypodensity on the CT scan.<br />
There is no fluid present.<br />
Secretory Phase Endometrium<br />
Secretory Phase Endometrium<br />
(Left) Longitudinal US shows<br />
nonspecific endometrial<br />
thickening ſt in a patient with<br />
irregular vaginal bleeding.<br />
(Right) US obtained during<br />
saline infusion<br />
sonohysterography in the<br />
same patient shows distention<br />
of the endometrial cavity<br />
without focal lesions. Slight<br />
lobularity of the endometrial<br />
lining is a normal finding<br />
("endometrial wrinkles").<br />
Secretory Phase Endometrium<br />
Secretory Phase Endometrium<br />
(Left) Transverse color<br />
Doppler US in a patient status<br />
post recent medical abortion<br />
demonstrates a thickened<br />
endometrium ſt with vascular<br />
flow st, consistent with<br />
retained products of<br />
conception. (Right) Pulsed<br />
Doppler US in the same<br />
patient shows low-resistance<br />
flow, typical of but not specific<br />
for retained products of<br />
conception.<br />
Retained Products of Conception<br />
Retained Products of Conception<br />
1050
Change language