Inflammation of endometrium
Occurs post parum, with PID, or after D&C
Endometritis: appears irregular; may demonstrate gas bubbles
*non neoplastic
Cystic vascular structures surrounding UT
Uterine Varicies "prominent arcuate vessels"
Extension of endometrial tissue to myometrium (usually post wall)
Adenomyosis (endometriosis): slight diffuse UT enlargement, hypoechoic myometrium, can be focal like fibroid
Associated with pain and abnormal bleeding
Endometrial growth extending into canal from a stalk
Endometrial polyp: thick echogenic endometrium with focal echogenic mass
DDx: endo ca or hyperplasia
Unopposed estrogen stimulation from ovarian dysfunction * non neoplastic
Occurs immediately after menarche and prior to menopause
Endometrial Hyperplasia: echogenic and thickened endometrium
Associated with irregular bleeding
DDx: endo ca. And polyp
Hymen does not rupture causing retention of fluid in UT or vagina
Imperforate hymen
Retention of vaginal secretions pre-puberty
Hydrocolpos
Retention of blood in vagina post-puberty
Hematocolpos
Retention of blood in UT (cx stenosis)
Hematometra
Retention of fluid in vagina and UT (pre menses or post menopause)
Hydrometrocolpos
Retention of blood in vagina and UT
Hematometrocolpos
Cysts along lateral or antrolateral vagina
Gartner duct cysts: mesonepheric duct remnants
Small, asymptomatic
May be associated with renal abnormality
Multiple entrapped cervical secretions from cervisitis
Nabothian cysts (retention cysts): common, vary in size
Solid retrovesical mass, may cause obstruction and fluid retention
Carcinoma of cx:usually dx clinically; u/s used to stage
This is caused by trauma, D&C, DES, or idiopathic
Incompetent cx
My cause preterm labor
Tx with "cerciage" stitch
External genitalia not clearly of either sex
Ambiguous genitalia
Possessing both male and female sex traits
Hermaphroditism
Possessing both ovarian and testicular tissue (infertile) may be due to fusion of 2 heterozygous twin zygotes after fertilization
True hermaphroditism
Increase risk for cancer
Possessing chrom of one sex but developing sex traits of other
Male pseudo: genetically male (testes) with female characteristics ( breasts, etc) due to lack of androgens
Female pseudo: genetically female (ovaries) with male characteristics (penis, scrotum, etc) due to excessive androgens
Infection of female genital tract
caused by STD, pyogenic(IUCD, sx), abortion, Crohns
Pelvic inflammatory disease(PID)
Tubal walls thickened and edematous
Salpingitis
If tube is blocked (pyosalpinx)
If treated infected material is resorbed (hydrosalpinx - if fluid is not resorbed))* chronic
Perihepatitis ( liver capsule) small absesses may lead to adhesions
Fitzhugh Curtis SyndromeRUQ pain on inspiration
Increase liver enzymes
5-10% have PID
50-80% asymptomatic, tenderness, vaginal discharge (endometritis) Thick endometrium, fluid in canal, or normal (difficult to dx)
Stage 1 of PID
Fever, chills, acute pelvic pain, abnormal bleeding (causes salpingitis) Pyosalpinx, hypo S shaped tubes with low level echoes
Stage 2 of PID
Tubo ovarian abscess, acute abd pain, increase WBC ( develops FHC) Multilocular mass, low level echos with fluid levels; multi complex masses, irregular borders, air in mass
Stage 3 of PID
Acute/subacute recurrence of PID
Distended s shaped tubes (hydrosalpinx) thin walls
Chronic PID
DDx: ovarian cyst, small cystadenomas
Growth of endometrial tissue outside UT cavity caused by retrograde tubal transmission; ? Estrogen stimulation
Can cause adhesions
Well defined predominately cystic mass with low level echoes, may see fluid level
AKA chocolate cyst
Inability to conceive after 12 months of unprotected sex
Infertility
Woman causes of infertility 40%
Ovarian: dysfunction, inability to transport, adhesions, endometriosis
Uterine: fibroids, ashermans
Cervical
Immunologic
Male causes of infertility 40%
Vairocele: congestion of veins in testes
Testicular failure: torsion, orchitis, cancer
Tubular obstruction
Cryptochi
Endometriosis is commonly seen on u/s?
False
(Functional Simple cystic Ovarian Mass) LH and FSH stimulate ovary to mature oocyte, follicles grow from 3 to 24 mm in about 10 days Functional/physiological
Evolves to corpus luteum after rupture
Follicular Cysts
(Functional simple cystic ovarian mass)
Occurs after ovulation
Resolves in 8 weeks without pregnancy, 12/15 weeks with pregnancy 1-10cm odd shape
Corpus luteum cysts
Follicular or corpus luteum cysts growing large effort rupture
Persistent cysts
Bleeding into cysts
May cause acute pain
Hemorrhagic cysts
(Physiological Simple cystic ovarian mass)
Remnants of embryonic ducts Never surrounded by ovarian tissue
Asymptomatic
1-4cm
Paraovarian cyst
"Broad ligament"
"Paratubal"
(Simple cystic)
Located higher in abdomen (omentum)
Omental cysts
(Simple ovarian cysts)
Mass located midline, anterior abdomen wall between umbilicus and bladder
Urachal cysts
(Multi bilateral ovarian cyst) Large mass caused by excessive hCG
Associated with multi gestation, molar, choriocarcinoma, hyperstimulation
May hemorrhage, rupture, torsion
Theca luteum cysts
Theca lutean cysts with ascites
Pergonal overstimulation
Hyperstimulation
PCO
Polycystic ovaries
"Stein leventhal syndrome"
(Multiple bilateral cystic masses)
Unopposed estrogen with no LH surge
Increase in androgen secretion/abnormal estrogen and androgen production (anovulation) Enlarged ovaries with multiple small cysts around periphery (string of pearls)
(Multiple bilateral cystic masses)
Increased/decreased ovarian echo texture due to necrosis from this?
Complete ovarian torsion
(Mixed Solid/Cystic Ovarian Masses)
Three types of neoplastic tumors?
Epithelial
Germ cell
Connective tissue tumors
(Mixed Solid/Cystic Ovarian masses)Epithelial
Simple cystic tumor Benign, often unilateral
Menstrating age group
Variable size (larger), Multiple thin septations
Serous cystadenoma
*most common
(Mixed Solid/Cystic Ovarian masses)Epithelial
Cystic ovary with irregular texture Malignant Ascites
Large >10cm
Serous cystadenocarcinoma
* most common malignant
(Mixed Solid/Cystic Ovarian masses)Epithelial
Benign Unilateral
Mass with low level echos/complex
May rupture due to size (15-30cm)
Mucinous cystadenoma
(Mixed Solid/Cystic Ovarian masses)Epithelial
Rare Malignant
Complex associated with ascites
Often unilateral
Risk of "pseudomyxoma peritoni"
Mucinous cystadenocarcinoma
(Mixed Solid/Cystic Ovarian masses)Epithelial
Malignant
Menopausal age >60yrs
Large unilateral >10-15cm
Complex - solid
Associated with endometrial cancer
Endometrioid
(Mixed Solid/Cystic Ovarian masses)Epithelial
Complex Unilateral Malignant
Variant of endometrioid
(Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal
Solid Benign
Small masses with variable hemorrhagic changes
Produces estrogen: precocious puberty
Granulosa cell tumor
"Theca luteal cell tumor"
"Thecoma"
(Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal
Solid hypoechoic/necrosis Unilateral
Usually benign
Produces androgens
Androblastoma
"Sertoli-leydig cell tumor"
(Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal Unilateral may be multiple masses
Post menopausal Solid (similar to fibroid)
Associated with Meigs syndrome
Fibroma/fibrosarcoma
Hydro thorax and ascites with an ovarian mass
Meigs Syndrome
Bilateralmetastatic ovarian tumors that produce mucin
Krukenbergs tumor
Bilateral Solid or necrotic
Large
Common from GI or Breast
Secondary/metastatic ovarian tumors
Ca 125
Antibody detecting ovarian cancer
CHEETAH
Acronym for similar looking ovarian masses
