51 Dr Ahmed Esawy imaging oral board of female pelvis part I ultrasound
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Transcript of 51 Dr Ahmed Esawy imaging oral board of female pelvis part I ultrasound
The Art of Radiology
3-dimensional coronal image of a unicornuate uterus.
2-dimensional image of a didelphic uterus with a gestational sac (arrow) in the left horn
2-dimensional transabdominal coronal view of a bicornuate uterus
3-dimensional coronal view of an arcuate shaped uterus
Hysterosalpingogram of an arcuate uterus
MRI of a bicornuate uterus. The arrows indicate two uterine horns.
3-dimensional coronal view of a septated uterus
NORMAL OVARY
MENOPAUSAL OVARY
The normal typical appearance of the infantile uterus
NORMAL OVARY
:Transverse US scan shows normal ovaries (arrows) with visible follicles
:appearence Uniform solid Baseline
Serial monitoring Day 9: Small Follicles Just Apparent.
ECTOPIC.RING SIGN
.Tubal pregnancy circled in red, 4.5 mm fetal pole (between cursors) in green, pregnancy yolk sac blue
CASE
This is the peripheral component of the complex mass that was seen in the right adnexa. It appears to be an enlarged and heterogeneous right ovary with peripherally
displaced follicles - this is classical for torsion.
This is a normal appearance of the right ovary .
Color Doppler demonstrates normal flow within the right ovary
The left ovary is enlarged, has an abnormal gray scale appearance and appears heterogeneous .
There is scant internal and peripheral flow .
Gray-scale sagittal image reveals right ovary to be enlarged (7 cm) with peripheral follicles and areas of increased echogenicity
Color Doppler demonstrates no flow within the ovary .
Power Doppler confirms almost no flow in the ovary .
OVARIAN TORSION
OVARIAN TOSION
OVARIAN TOSION
OVARIAN TOSION
OVARIAN TOSION
OVARIAN TOSION
TORSION
There is a complex mass seen in the right adnexa. The right ovary is not seen separate from the
Spectral analysis demonstrates a normal arterial waveform. The venous waveform however, could not be obtained, implying that the venous supply is probably compromised .
The complex heterogeneous mass is again noted in the right adnexa. It is predominantly hypoechoic with a few cystic areas within the mass.
The contralateral left ovary appears normal and shows prominent follicles within .
This is the peripheral component of the complex mass that was seen in the right adnexa. It appears to be an enlarged and heterogeneous right ovary with peripherally displaced follicles - this is classical for torsion.
Case Isolated left tubal torsion
The uterus with the normal endometrial stripe is notedIsolated left tubal torsion
There is a hypoechoic structure seen in the left adnexa that appears cystic, contains low-level internal echoes,some debri and thin septae. The mass shows good posterior
enhancement. Isolated left tubal torsion
The cystic structure is noted again and shows very thin, barely perceptible walls. The patient had probe tenderness while scanning
this structure Isolated left tubal torsion
The cystic structure is noted again displaying the homogeneous low-level internal echoes Isolated left tubal torsion
Case Left ovarian torsion
This is a normal appearance of the right ovary .
Color Doppler demonstrates normal flow within the right ovary Left ovarian torsion
The left ovary is enlarged, has an abnormal gray scale appearance and appears heterogeneous. Left ovarian torsion
There is scant internal and peripheral flow. Left ovarian torsion
Case ovarain torsion Gray-scale sagittal image reveals right ovary to be enlarged (7 cm) with peripheral follicles and areas of increased
echogenicity
Color Doppler demonstrates no flow within the ovary .
Power Doppler confirms almost no flow in the ovary .
a) Transverse ultrasonography shows a solid right adnexal mass; b) Longitudinal ultrasonography shows a tubular right ovarian vein extending superiorly from the adnexal mass towards the inferior vena cava (IVC). c) Transverse ultra-sonography shows thrombus in the right ovarian
vein adjacent to the IVC. Blood flow was visible in the IVC on colour Dopplerbut not in the ovarian vein
a) CT through the lower abdomen shows low attenuation thrombus distending the right ovarian vein. b) CT at the level of the kidneys shows thrombus extending into the IVC. c) CT shows a solid adnexal mass adjacent to
the enlarged uterus . Post-partum ovarian vein thrombosis POVT
a) CT through the lower abdomen shows low attenuation thrombus distending the right ovarian vein. b) CT at the level of the kidneys shows thrombus extending into the IVC. c) CT shows a solid
adnexal mass adjacent to the enlarged uterus .
Multiple tiny follicles are seen scattered throughout the right ovary /PCO .
Multiple, small follicles are seen scattered in the right ovary/PCO .
Multiple follicles are seen scattered in the left ovary. A densely echogenic area showing significant posterior acoustic shadowing is noted in the ovarian stroma/PCO
This image shows an echogenic ovarian mass. The posterior margins of the mass are obscured. These features along with the calcification seen in the previous image are suggestive of an ovarian dermoid .
PCO
TOA
PYOSALPNIX
TOA
TOA
TOA after 1o days
PYOSALPNIX
left TOA The uterus appears normal. A large cystic mass is seen in the left adnexa which demonstrates homogeneous, low-level internal echoes. The left
ovary is not visualized separate from this mass .
The cystic mass has a smooth wall except for one loculated area that exhibits thick irregular walls. The medial wall of the locule demonstrated blood flow
on Doppler [not shown here] .
The complex adnexal cyst is noted again, demonstrating low level internal echoes. A thin septum is seen extending from the wall. The mass
appears to be contained within the left ovary (compressed ovarian tissue is seen around the entire periphery) .
The right ovary is seen in this image and exhibits a small cyst with septations .
The right ovary in a different plane shows multiple cystic areas, some of which are septated. The
rest of the ovarian tissue appears somewhat inhomogenous.
Pubic osteomyelitis with an abscessheterogeneous soft tissue mass is noted anterior-inferior to the urinary bladder in the region of
the symphysis pubis, indenting the bladder contour. The bladder wall appears thickened adjacent to the lesion. The uterus appear normal .
Pubic osteomyelitis with an abscessThe heterogeneous soft tissue mass is noted again in this parasagittal image. Irregular echogenic areas are noted caudal to the mass. These echogenic areas cause complete shadowing beneath
them
Pubic osteomyelitis with an abscessThis image shows the extent of the mass more clearly. The mass appears to involve the superficial soft tissues.
The irregular echogenic areas are also seen more prominently here
Pubic osteomyelitis with an abscessThe mass in this transverse view shows a hypoechoic center. This is suggestive of
necrosis .
Pubic osteomyelitis with an abscess Color Doppler shows some flow within the mass .
Pubic osteomyelitis with an abscess Color Doppler of the mass in a different plane
Left ovarian abscess and related IUCD in situ
The endometrial cavity shows a linear, high amplitude echo. This possibly represents a retained piece of the IUCD.
Left ovarian abscess and related IUCD in situ The linear echo within the endometrial cavity is noted again in this image
Left ovarian abscess and related IUCD in situ complex left adnexal cystic mass is noted. The mass is septated and the left ovary could not be identified separately from it .
Left ovarian abscess and related IUCD in situ The left sided cystic adnexal mass exhibits thick septations. The fluid within the mass shows inhomogeneous echoes within .
Left ovarian abscess and related IUCD in situ The septated cystic left adnexal mass is seen again. The thick septations appear quite
irregular, raising a suspicion for neoplasm
Left ovarian abscess and related IUCD in situ The transvaginal scan better demonstrates the internal characteristics of the complex mass in the left adnexa. The thick septae and the inhomogeneous echoes in the
different fluid compartments of the mass are better appreciated in this view
TVS of a cystic mass with a thick and irregular wall . This was an ovarian carcinoma
TOA
TOA after 1o days
HYDROSALPNIX
hydrolpnix
Adnexal mass reveals fluid debris level consistent with hydrosalpnix
SIMPLE UNILOCULAR CYST
Ultrasound: Benign ovarian cyst
FOLLICULAR CYST
A thin-walled cyst (C) with anechoic internal fluid and size larger than 2.5 cm meets the definition of a functioning ovarian cyst
FOLLICULAR CYST
FOLLICULAR CYST
FOLLICULAR CYST
CLC
MATURE CORPUS LUTEUM
SOLID CORPUS LUTEUM
CORPUS LUTEUM+SOLID LESION
SIMPLE CYST+SOLID CORPUS LUTEUM
THECA LUTEUN CYST
THECA LUTEUN CYST
Theca-lutein cysts replacing an ovary in a patient with a molar pregnancy. Despite their size these cysts are benign and usually resolve after treatment of the
underlying disease
PARAAOVARIAN CYSTS
PARAAOVARIAN CYSTS
PARAOVARIAN CYST
PARAOVARIAN CYST
SIMPLE UNILOCULAR CYST
HAEMORRHAGIC CYST
A thin-walled cyst (C) with anechoic internal fluid and size larger than 2.5 cm meets the definition of a functioning ovarian cyst
SIMPLE UNILOCULAR CYST
POSTMENOPAUSAL CYST
POSTMENOPAUSAL CYST
ENDOMETRIOMA
ENDOMETRIOMA
endometrioma
ENDOMETRIOMA
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
HGIC CYST(A)
HGIC CYST(B)
(A ) Hemorrhagic corpus luteumwithin the left ovary containing fibrin - , strands appearing as a web like complex of thin branching linear . ) ( , 6 , interface B Same patient as in A week later showing complete
regression.
Hgic cyst
HAEMORRHAGIC CYST
STIMULATED OVARY
STIMULATION WITH HORMONAL THERAPY
Dermiod cyst
Dermiod cyst
CT dermiod cyst
CYSTIC TERATOMA
Immature teratoma
DERMIOD-TERATOMA
DERMIOD-TERATOMA
DERMIOD-TERATOMA
DERMIOD-TERATOMA
DERMIOD-TERATOMA
DERMIOD-TERATOMA
DERMIOD-TERATOMA
BENIGN TERATOMA
CYSTIC TERATOMA
Mature cystic teratoma
DERMIOD-TERATOMA
THICK WALLED CYST
Ovarian fibroma
Fibriod cyst
Predominantly cystic right adnexal mass containing papillary excrescences. papillary serous tumour and fibroma
Doppler demonstrates low-impedance blood flow within the excrescences. papillary serous tumour and fibroma
3D pelvic sonography clearly demonstrated the internal papillations within the right adnexal mass. papillary serous tumour and fibroma
Endovaginal sonography of the left adnexal mass shows a solid lesion with moderate internal flow on color Doppler. The mass is adjacent to the uterus papillary serous tumour and fibroma
STIMULATED OVARY
STIMULATION WITH HORMONAL THERAPY
STIMULATED OVARY
STIMULATION WITH HORMONAL THERAPY
Sepated cystic masses ( A ) Transverse TAS showing cystic mass containing multiple thin internal septations , representing mucinous cystadenoma
Transverse TAS showing septated mass with echogenic material ( * ) in upper loculated area . The echogenic material was mucin within this
mucinous cystadenoma
The septated cystic left adnexal mass is seen again. The thick septations appear quite irregular, raising a suspicion for neoplasm
Sepated cystic masses ( A ) Transverse TAS szzzxhowing cystic mass containing multiple thin internal septations , representing mucinous cystadenoma . ( B ) Transverse TAS showing septated mass with echogenic material ( * ) in upper loculated area . The echogenic material
was mucin within this mucinous cystadenoma
Malignancy was suspected due to thickened septation ( arrow) within this mucinous cystadenocarcinoma
Serous cystadenocarcinoma
Benign cystadenoma
(G ) ) ( and axial H TVS shwing amultiloculated septated cystic mass with focal . wall thickening this represented a mucinous cystadenoma with one locule
containing thick mucinous material
A complex heterogeneous mass with cystic spaces within is noted filling the posterior cul de sac and displacing the uterus and broad ligaments anteriorly
TVA A complex right sided cystic mass is noted with the mass showing very thin septations .
Transvaginal scan demonstrating better the characteristics of the cystic mass in the pelvis .
Again seen is a cystic septated mass in the pelvis with no obvious mural
nodularity or solid components within
The cystic mass demonstrated in another view. The bands of weak echoes seen
crossing the larger cystic compartments are artifacts
Transverse TAS of complex predominantly cystic right – adnexal mass with calcific
focus ( arrow ) arising from tooth within this dermoid cyst
TVS of a pelvic mass in a woman with a renal transplant. This w as found to represent a luteal cyst with fluid surrounding adhesion Sagittal
(A ) ) ( and axial B TVS shwing a multiloculated septated cystic mass . with focal wall thickening this represented a mucinous cystadenoma
with one locule containing thick mucinous material
Complex predominantly cystic masses . ( A ) TVS of endometrioma ( curved arrow ) that contained echogenic clot located adjacent to mature follicle ( straight arrow}
TVS of tubovarian abscess. Abscess cavity was surrounded by ovarian tissue) * (
TVS of a hemorrhagic corpus luteum cyst with trosed left ovary
Transverse TAS showing cystic right – adnexal mass with septations or stands ( arrow ) .
representing an appendiceal abscess in a partum patient.
Cystic mass with small focus of solid tissue morphologically similar to a papillary excrescence ( arrowhead ) This mass was bening
TVS of a right ovary that contains two cystic masses ; one has a papillary excescence . This was a border – line ovarian cancer adjacent to a mature follicle
Complex predominantly cystic masses . ( A ) TVS of endometrioma ( curved arrow ) that contained echogenic clot located adjacent to mature follicle ( straight arrow
Predominantly cystic right adnexal mass containing papillary excrescences. papillary serous tumour and fibroma
Doppler demonstrates low-impedance blood flow within the excrescences. papillary serous tumour and fibroma
Cystic mass with small focus of solid tissue morphologically similar to a papillary excrescence ( arrowhead ) This mass was bening . ( L ) TVS of a right ovary that contains two cystic masses ; one has a papillary excescence . This was a border – line ovarian cancer adjacent to a mature
follicle
Complex predominently solid / dermiod cyst
TVS of granulosa cell tumour
Tvs of dermiod cyst with layer ofd dermiod sebum
TVS of haemorrhagic cyst
TAS of ovarian cystadenoma carcinoma
Magnified TAS of cul-de sac haemorrhage(arrow) resulting from ruptured ectopic pregnancy
TVS of a dermiod cyst contianin typical hair ball(arrow)
A-SOLID MASSES A-TAS enlarged right ovary(between cursor}with ecgogenic area consistent with haemorrahge due to ruptureds ovary
(B) same patient in A show intraperitoneal fluid due to ruptured ovary
Longitudanl TAS demonstrating solid area in culdesac(arrow)arising from torsed right ovary. Same patient in (A) with transverse TAS show normal left ovary(straight arrow)adgacent to
torsed right ovary(curved arrow)
Interligamentous fibriod appearing as solid pelvic mass
Myxomatous uterine tumor (Ilarge armw) arising from uterine fundus {curved arrow). (B) Same tumor . Ultrasound shows estent of tumor (*), which occupies entire abdomen.
TAS of a solid pelvic mass with calcifications (arrow) in elderly patient
Ovarian fibroma
Longitudinal TAS of pelvic kidney (arrow). Pelvocalvceal system accounts for central echogenicity
Magnified transverse TAS showing solid leti—adnexal mass jhcii ci’n cursor.). which represents a hemorrhagic corpus luteum cyst .
Longitudinal TAS ot solid teratoma with calcified areas
Magnified TAS of solid mass (between) representing hemorrhagic corpus luteum cyst
Sagittal and transverse TAS showing a 5 X 7 cm solid mass associated with ascites. This was ovarian cancer .
TVS of loculated fluid with peritoneal adhesions that mimic the appearance of
a cystadenoma.
TVS (A) and TAS (B) of a patient presenting with right lower quadrant pain. The T\’S shows a normal uterus. Compression TAS demonstrated a thickwalled appendix. This patient had
appendicitis at surgery
TVS of a patient following bowel surgery showing a peritoneal “pseudocvst’ or loculated fluid in the right lower quadrant `````
TAS through area of cuIde-sac showing intraperitoneal fluid
hemorrhagic corpus luteum (between cursors)
Long (A) and short (B) axes of fusiform mass in the right tower quadrant are consistent with a thickened appendix. Appendicitis was confirmed at surgery .
TVS of a walled-off appendiceal abscess adjacent to adhesed small bowel hops
TVS of solid mass containing ringlike interfaces. This was found to be a mucocoele
Frequency transvaginal color Doppler stinogram ( TV-CDS) showing low- impedance (pulsatility index of 0.6), low-veloctty (maximum systemic velocity l() cm s) flow in the wall of the corpus
luteum .
Amplitude TV-CDS shows ,more intraparenchyrnal vascularity than that with frequency-based TV-CDS
A complex heterogeneous mass with cystic spaces within is noted filling the posterior cul de sac and displacing the uterus and broad ligaments anteriorly
TVA A complex right sided cystic mass is noted with the mass showing very thin septations .
Transvaginal scan demonstrating better the characteristics of the cystic mass in the pelvis .
Again seen is a cystic septated mass in the pelvis with no obvious mural
nodularity or solid components within
The cystic mass demonstrated in another view. The bands of weak echoes seen crossing the
larger cystic compartments are artifacts
/Mature Cystic Ovarian Teratoma D ermoid Cyst