Diagnostic Ultrasound - Abdomen and Pelvis
Uterus NORMAL VARIATIONS, UTERINE POSITION Anatomy: Pelvis Endometrium Uterine fundus Folding of anterior uterine wall Vaginal mucosa Cervix Endometrium Cervix Folding of posterior uterine wall Uterine fundus Endometrium Orientation of vagina Orientation of cervix Uterine fundus (Top) Longitudinal TA ultrasound of an anteverted, anteflexed uterus shows the uterine cervix is angled forward with respect to the vagina, and the uterine body is angled forward with respect to the cervix. Version refers to the angle of the cervix relative to the vagina. Flexion refers to the angle of the uterine body relative to the cervix, i.e., the uterus and the cervix are not in a straight line. (Middle) Uterine retroflexion. This is an anteverted uterus with exaggerated retroflexion in which the uterus resembles a boxing glove. Folding of the posterior uterine wall may be confused with an intramural fibroid. (Bottom) Uterine retroversion is shown. The orientation of the uterus and cervix is posterior with respect to the vagina. Retroversion frequently limits transabdominal evaluation of the uterus, as seen here. 143
Uterus Anatomy: Pelvis UTERINE VARIATIONS WITH AGE Vagina Uterine body Cervix Uterine body Cervix Uterine body Cervix (Top) Longitudinal TA ultrasound shows an immediate neonatal uterus (day 2). The uterus is prominent with a bulbous cervix and a rudimentary body. The endometrium is seen as a thin, echogenic line, which may be due to stimulation by the residual maternal hormones. (Middle) Longitudinal TA ultrasound shows a prepubertal uterus in a patient 8 years old. The uterus demonstrates a tubular appearance with the length of the cervix nearly double that of the uterine body. (Bottom) Longitudinal TA ultrasound shows an early pubertal uterus in a patient 12 years old. The body length of the uterus approximates the cervical length with the endometrium, changing in appearance and thickness during the menstrual cycle. At this time, the uterine body grows dramatically until it reaches the adult size. 144
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Uterus<br />
NORMAL VARIATIONS, UTERINE POSITION<br />
Anatomy: <strong>Pelvis</strong><br />
Endometrium<br />
Uterine fundus<br />
Folding of anterior uterine wall<br />
Vaginal mucosa<br />
Cervix<br />
Endometrium<br />
Cervix<br />
Folding of posterior uterine wall<br />
Uterine fundus<br />
Endometrium<br />
Orientation of vagina<br />
Orientation of cervix<br />
Uterine fundus<br />
(Top) Longitudinal TA ultrasound of an anteverted, anteflexed uterus shows the uterine cervix is angled forward with respect to the<br />
vagina, <strong>and</strong> the uterine body is angled forward with respect to the cervix. Version refers to the angle of the cervix relative to the vagina.<br />
Flexion refers to the angle of the uterine body relative to the cervix, i.e., the uterus <strong>and</strong> the cervix are not in a straight line. (Middle)<br />
Uterine retroflexion. This is an anteverted uterus with exaggerated retroflexion in which the uterus resembles a boxing glove. Folding<br />
of the posterior uterine wall may be confused with an intramural fibroid. (Bottom) Uterine retroversion is shown. The orientation of the<br />
uterus <strong>and</strong> cervix is posterior with respect to the vagina. Retroversion frequently limits transabdominal evaluation of the uterus, as seen<br />
here.<br />
143
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