1. Gynecologic imaging
(OSCE slides )
Prepared by
Supervised by
Dr. Alaa Elsayed
Dr. Mohammed Hesham
Professor of Obstetrics and Gynecology
Al-Azhar University
Cairo , Egypt
(17/7/2022 )
2. A B
C D
What is the likely
diagnosis of these
ultrasound pictures of
ovarian masses ?
Q 1
3. A- Simple cyst
B- Haemorrhagic cyst
C- Endometrioma
D- Dermoid cyst
Q 1- Answer
A B
C D
4. Updates in the diagnosis and management of ovarian mass
▪ History
▪ Examination
▪ Investigations
o Ultrasound
o …………..
o ……………
7. A B
C D
Four sonographic pictures
of the endometrium
1. Which image
corresponds with
secretory phase of
menstrual cycle ?
Q 2
2. How would you
measure
endometrial
thickness ?
8. Q 2- Answer
1. Which image corresponds with
secretory phase of menstrual cycle ?
2. How would you measure
endometrial thickness ? D
Image D
• Sagittal plane of the uterus
• The central endometrial echo is contiguous with the endocervical canal
• one caliper at the echogenic interface of the anterior basale layer and myometrium.
• The other at the similar echogenic interface of the posterior basale layer.
• The hypoechoic halo outside the endometrium is not included
9. • in the menstrual and early proliferative phase it is a
thin, brightly echogenic stripe comprising of the basal
layer (figure 1); minimal fluid can be appreciated
endovaginally within the endometrium in the
menstrual phase
• in the late proliferative phase it develops a trilaminar
appearance: outer echogenic basal layer, middle
hypoechoic functional layer, and an inner echogenic
stripe at the central interface (figure 2).
• in the secretory phase it is at its thickest, up to 16
mm 10, and becomes uniformly echogenic, as the
functional layer becomes edematous and isoechoic to
the basal layer (figure 3); there is through
transmission and posterior acoustic enhancement
noted
The endometrium appearance correlate with the phasic
changes of the menstrual cycle
(figure 1)
(figure 2)
(figure 3)
10. 1. What is the name of investigation A ?
2. What is the diagnosis in picture B ?
3. Mention two radiologic features of this diagnosis.
Q 3 A B
• 25 year old woman
presents with
intermenstrual bleeding
• Investigation (A) was
performed
• Picture (B) was found
11. 1. What is the name of investigation A ?
• Sonohysterography ( saline infusion sonography )
2. What is the diagnosis in picture B ?
• Endometrial polyp
3. Mention two radiologic features of this diagnosis.
• Echogenic
• Narrow base
• Single feeding vessel
A B
Q 3- Answer
12. Definition : Endometrial polyps are hyperplastic overgrowths of endometrial glands and stroma that form a
projection from the surface of the endometrium (lining of the uterus)
Clinically :
• Endometrial polyps are a common cause of abnormal uterine bleeding in both premenopausal and
postmenopausal women.
• Intermenstrual bleeding is the most frequent symptom in premenopausal women with endometrial polyps
• They may also be asymptomatic
Ultrasound
• During menses the endometrium is thin, and fluid may be present in the endometrial cavity. During the
follicular phase, the endometrium is hypoechoic and thin.
• Doppler imaging should be added to assess for a feeding vessel or vascular stalk, which also helps indicate
from which wall of the uterus the polyp arises
Q 3- Explanation
13. Endometrium during secretory phase
Endometrium after menses showing
hypoechoeic endometrium and echogenic
endometrial polyp
• Timing of scanning during the first week after menses may allow more optimal
detection of endometrial pathology such as polyps because polyps tend to be
echogenic and will be more easily visualized against the background of a thin
hypoechoic endometrium
14. Hysterosonography (sonohysterography, salineinfused sonography)
• Definition :is defined as TVUS performed during the instillation of saline into the
uterine cavity.
• Procedure :
• After cleansing and/or sterile preparation of the vaginal introitus, a speculum is
introduced into the vaginal canal and the cervix identified.
• Once prepped with povidone–iodine or other solution, a 5-French balloon-tipped
catheter is gently placed through the cervical os into the endometrial cavity, and the
balloon is expanded against the internal cervical os.
• The speculum is removed, and a TVUS probe is placed into the vagina adjacent to
the catheter.
• As sterile saline is infused, images of the endometrium are obtained in multiple
planes.
15. Q 4
• 32 year old woman with primary
infertility for 3 years
• HSG was performed and image is
attached.
• IVF is planned .
1. What is the diagnosis ?
2. Mention two ultrasound features of
this diagnosis .
3. What is the preferred management
before IVF ?
16. 1. What is the diagnosis ?
• Hydrosalpnix
2. Mention two ultrasound features of this diagnosis .
• Dilated tubular structure
• Incomplete septi
• Cogwheel sign
3. What is the preferred management ?
• Laparoscopic salpingectomy before IVF
Q 4- Answer
21. • 27 years old woman with
history of repeated
midtrimester pregnancy loss
• HSG (image A) – shows two
uterine cavities
• 3D ultrasound (image B )
was performed to clarify the
diagnosis
Q 5
1. What is the diagnosis ?
2. Mention two other methods to clarify the diagnosis
3. What is the treatment ?
B
A
22. Q 5- Answer
1. What is the diagnosis ?
• Uterine septum
2. Mention two other methods to clarify the diagnosis
• MRI
• Combined hysteroscopy and laparoscopy
3. What is the treatment ?
• Hysteroscopic septum resection
