Diagnostic Ultrasound - Abdomen and Pelvis
Cervix GRAPHICS OF CERVIX ANATOMY Anatomy: Pelvis Endometrial canal Internal os Endocervix Endocervical canal Posterior fornix of vagina Vesicouterine pouch Ectocervix External os Anterior fornix of vagina Vaginal canal Bladder Prevesical space (space of Retzius) Paravesical space Vesicocervical/vesicovaginal space Cardinal ligament Rectovaginal space Pararectal space Uterosacral ligament Presacral space (Top) Median sagittal graphic shows the cervix, which begins at the isthmus, the inferior narrowing portion of the uterus. It has a supravaginal portion (endocervix) and a vaginal portion (ectocervix), which divides the vagina into shallow anterior fornix, deep posterior, and lateral fornices. (Bottom) Graphic shows the female pelvic ligaments and spaces at the cervical/vaginal junction. The ligaments are visceral ligaments, which are composed of specialized endopelvic fascia and contain vessels, nerves, and lymphatics. Some of the main supporting ligaments for the uterus are attached to the cervix, which are cardinal and uterosacral ligaments. The spaces are largely filled with loose connective tissue and are used as dissection planes during surgery. 151
Cervix Anatomy: Pelvis TRANSVAGINAL ULTRASOUND OF CERVIX Internal os External os Free fluid in cervical canal Vaginal fornix Cervical stroma Submucosal layer Mid cervical canal with thin mucosal layers Internal os External os Nabothian cysts Submucosal layers Free fluid in rectovaginal pouch (Douglas) (Top) Sagittal transvaginal ultrasound of the cervix shows hypoechoic fluid present in the endocervical canal. The endocervical canal is rich in mucus-secreting glands. The mucus secreted is usually slightly echogenic but becomes hypoechoic during periovulatory phase. As the transducer abuts the anterior lip of the cervix, the posterior wall of the vaginal fornix can be seen to cover the external os and extend along the posterior lip of the cervix. (Middle) Transverse transvaginal ultrasound of the cervix at the lower endocervical canal shows a typical appearance with an echogenic mucosal layer, a hypoechoic band of the submucosal layer, and intermediate echogenic stroma. The submucosal layer is filled with mucus-secreting glands leading to its hypoechoic appearance. (Bottom) Longitudinal transvaginal ultrasound shows the transducer abutting the anterior lip of the external os. The submucosal layer is thickened with typical low echogenicity. 152
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Cervix<br />
Anatomy: <strong>Pelvis</strong><br />
TRANSVAGINAL ULTRASOUND OF CERVIX<br />
Internal os<br />
External os<br />
Free fluid in cervical canal<br />
Vaginal fornix<br />
Cervical stroma<br />
Submucosal layer<br />
Mid cervical canal with thin mucosal<br />
layers<br />
Internal os<br />
External os<br />
Nabothian cysts<br />
Submucosal layers<br />
Free fluid in rectovaginal pouch<br />
(Douglas)<br />
(Top) Sagittal transvaginal ultrasound of the cervix shows hypoechoic fluid present in the endocervical canal. The endocervical canal is<br />
rich in mucus-secreting gl<strong>and</strong>s. The mucus secreted is usually slightly echogenic but becomes hypoechoic during periovulatory phase. As<br />
the transducer abuts the anterior lip of the cervix, the posterior wall of the vaginal fornix can be seen to cover the external os <strong>and</strong><br />
extend along the posterior lip of the cervix. (Middle) Transverse transvaginal ultrasound of the cervix at the lower endocervical canal<br />
shows a typical appearance with an echogenic mucosal layer, a hypoechoic b<strong>and</strong> of the submucosal layer, <strong>and</strong> intermediate echogenic<br />
stroma. The submucosal layer is filled with mucus-secreting gl<strong>and</strong>s leading to its hypoechoic appearance. (Bottom) Longitudinal<br />
transvaginal ultrasound shows the transducer abutting the anterior lip of the external os. The submucosal layer is thickened with<br />
typical low echogenicity.<br />
152
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