1. By Ngouopayou D. Vienny
HPD MDIRT
B.Sc Medical Imaging Technology
dvngouopayou@stlouis-group.org
2. Be able to describe the most frequent
pathologies.
Be able to identify the various pathologies on
ultrasound
3. Congenital anomalies of the uterus
Endometrial disorders
Ovarian cyst and cystic neoplasms
Pelvic inflammatory disease
4. Longitudinal scan of a normal anteverted
uterus with a thin visible mid line
endometrial echo
Longitudinal scan in a 4 year old female
child. The uterus is very small (arrows) seen
behind the bladder and almost obscured by
masses of faeces in the rectum
Uterine
fundus
Endometrial
Echo
Cervix
5. Unicornuate uterus: formation of just one
horn of the uterus
Uterine didelphys: two separate unicornuate
uteri with separate endometrium, cervix and
vagina
Bicornuate uterus: incomplete fusion of
mullerian ducts at the fundus. Fundal
differentiation of at least 1cm
6. Septate uterus: muscular septum separates
both horns and outer fundal wall is formed
normally
Arcuate uterus: demonstrates a slight,
rounded midline septum with a broad fundus
and sometimes has a small indentation at the
fundus.
9. Abnormal thickening of the endometrial
lining of the uterus
On ultrasound, it presents with thickened
(14mm) with uniform echotexture, but no
focal lession.
10.
11. Inflammation of the endometrial lining.
Present with fever, lower abdominal pain and
abnormal vaginal bleeding or discharge.
12.
13. Endometrial tissue growing outside the
uterus.
May be found on the surface of the uterus or
ovaries
Present with pelvic pain, pain during
intercourse and defecation.
On ultrasound, it presents with hypoechoic
tissue, often accompanied with cysts
(endometriomas)
14. ‘Adeno’ meaning ectopic.
Ectopic endometrial tissue in the
myometrium.
Often asymptomatic but may present with
menorrhagia and dysmenorrhea
15.
16. Growth attached to the inner wall of the
uterus
Usually non cancerous
common in menopause
Often asymptomatic but may present with
menopausal bleeding.
17.
18.
19. The endometrium increases in size and the
carcinoma invades the myometrium resulting
in poorly defined margins.
It is usually echogenic in the early stages but
as it increases in size may become
hypoechoiec with necrosis.
There may be a complex appearance.
20. An endometrial polyp also causes thickening
of the endometrium and is usually
indistinguishable from carcinoma.
A polyp may present as a more localised
thickening.
21.
22. Retention of blood in the vagina or uterus
Presents as a hypoecheoic mass within the
uterine cavity
23. Imperforate hymen. This usually present in
teenagers with a lower abdominal mass and
absence of menstruation
Genital mutilation following ritual female
circumcision and resultant scarring.
Caesarean section occasionally causes
obstruction to the normal menstrual flow if
there is marked scarring
Carcinoma of the cervix with a large mass
blocking the flow
24. o
Haematometrium in a 14 year old girl.
Cervical
blood
Blood in
vagina
Body of
the
uterus
A collection of blood within the endometrial cavity
due to obstruction by a carcinoma of the cervix
27. Benign
◦ Fibroid (also called myoma or leimyoma)
◦ Uterine polyps
Malignant
◦ Endometrial cancer
◦ Uterine sarcoma
28. There are 3 main types of fibroids.
Subserosal fibroids;
◦ Most common.
◦ Push outside the uterus into the pelvis.
◦ Some times can grow with a stalk that attaches them to
the uterus walls (pedunculated subserosal)
Intramural fibroids;
◦ They develop in the muscular walls of the uterus.
Submucosal fibroids;
◦ Very uncommon.
◦ Some times can grow with a stalk that attaches them to
the uterus walls (pedunculated submucosal fibroids
29.
30. Transverse scan of
the uterus showing a
hypoechoiec area in
the intramural part
on the R side of the
uterus. This was a
fibroid.
Multiple hypoechoiec rounded masses in the uterus
due to fibroids. The uterus is considerably enlarged.
Uterine fibroids. The larger one is arising from the fundus
and growing away from the uterus. The smaller one is in the
upper cervical region
34. They develop in the endometrium. This is the most
common type of uterine cancer accounting for more than
90% of cases.
There are 3 main types;
Serous adenocarcinoma; which are tumors that are more
likely to spread to the lymph node and other parts of the
body.
Adenosquamous carcinoma; they are rear uterine cancers
that cotain two types of cells. Squamous cells and gland
like cells.
Uterine carcinosarcoma; which has cancer cells that look
like endometrial cancer and sarcoma and has high risk of
spreading to the lymph node and other parts of the body
35. This a rarer type of uterine cancer that forms
in the muscles or other tissues of the uterus.
They make up less than 4% of cancer of the
uterus. There are main types;
Uterine leiomyosarcoma; they are the most
common type which forms in the muscular
walls of the uterus known as the myometrium
and it makes up 2% of uterine cancer
36. Endometrial stromal sarcoma; they develop in
the connective tissues the support the
endometrium. They grow slowly and
represent less than 1% of uterine cancer.
Undifferentiated sarcoma; it is similar
endometrial stromal sarcoma but more
aggressive. Meaning it grows and spreads
more quickly. They make less than 1% of
uterine cancers.
42. A simple cyst has smooth walls, no internal
echoes and shows acoustic enhancement.
A unilocular simple cyst less than 5 cm in
diameter is almost always benign.
Causes of simple cysts in the ovary are:
◦ Follicle – up to 2.9 cm
◦ Functional cyst – 3 cm and over but usually less than 6
cm
◦ Cystadenoma – may become very large
◦ Polycystic ovaries
43. Sac that forms on the surface of an ovary
during or after ovulation.
It holds the mature egg
Usually goes away after the egg is released.
If the egg is or released (follicular), or if the
sac closes up after the egg is released
(luteal), the sac can swell up with fluid.
44. Corpus luteum cyst
◦ Enlargement of and build up of fluid in the corpus
luteum after a failed regression following ovulation
◦ Produces progesterone which may delay menses
Theca lutein cyst
◦ often multiple cysts that typically develop bilaterally
◦ Results from exaggerated stimulation of the theca
interna cells of the ovarian follicles
45. Simple functional ovarian cyst.
Clear and smooth walled with
acoustic enhancement
Unilocular ovarian cyst with
acoustic enhnancement and a
smooth wall
A larger simple cyst lying above the
uterus. If large they may not be
found in the pelvis
46. This is a well defined cyst with a smooth wall
containing diffuse internal echoes but no
solid elements or septae. The commonest
causes are:
◦ Haemorrhagic cyst
◦ Endometrioma
47. A haemorrhagic cyst contains fine internal
echoes. Sometimes it appears echogenic.
A well defined cystic lesion in
the ovary containing fine
echoes within the lumen.
This could be a
haemorrhagic cyst or an
endometrioma
48. Chocolate cysts (endometrioma): a cyst-like
structure that contains blood, fluid and
mensrual debris. Caused by proliferation of
ectopic endometrial tissue (endometriosis)
An endometrioma can occur anywhere in the
pelvis, not just the ovary. It is well defined
with a smooth wall, dark with fine internal
echoes.
49. This is a benign congenital complex cyst, with
solid elements and fat.
Cyst often contains calcifications such as teeth
and there may be a fluid level due to layering of
fat with fluid.
If containing calcifications there will be acoustic
shadowing.
The appearances are often bizarre on ultrasound
and a dermoid occasionally will be completely
solid without any cystic elements.
50.
51. A diseased developed by hormonal
imbalance.
This imbalance leads to collection of mature
eggs in the ovaries as they cannot be
discharged.
These also become cyst and some of the
cysts lead to more cysts
Caused by insulin diets, hormone imbalance
and stress
52. An endocrine system disorder
High level of androgen than normal interfere
with egg development and release.
Some of the eggs develop into cysts.
53.
54.
55. Tiny cyst that forms on the surface of the
cervix
2 – 10mm
Can be caused by cervicitis.
Developed during childbearing ages and most
often after birth.
56.
57. Infection of the upper genital tract in women.
Can include endometritis, cervicitis,
salpingitis, hydrosalpinx, pyosalpinx, tubo-
ovarian abcsess and peritonitis
May present with lower abdominal pain, fever,
back pain, vomiting, abnormal vaginal
discharges or bleeding, itches or odor
Symptoms may be mild or even absent
58. Classic findings of acute PID on transvaginal
ultrasound are;
◦ tubal wall thickness greater than 5mm
◦ Incomplete septae within the tubes
◦ Fluid in the pouch of douglas
◦ Cogwheel sign
In more severe cases, ultrasound may show
adnexal masses with heterogenous echo-
pattern
59.
60.
61. A small, often T-shaped birth control device
that is inserted into the uterus to prevent
pregnancy
They are a form of long lasting reversible
methods of birth control.
62.
63. The material here is meant to guide you, do
well to study further.
Check on
◦ ‘Diagnostic Imaging ultrasound by Anil T. et al
◦ SANDLER’S Ultrasound
