Pelvic ultrasound radiology training resource nchanji nkeh keneth

RADIOLOGY TRAINING RESOURCE FOR MEDICAL
IMAGING TECHNOLOGISTS/SONOGRAPHERS,
NURSES, MIDWIVES AND RELATED MEDICS
Module 4:
Understanding PELVIC ULTRASOUND
Course lecturer
Nchanji Nkeh Keneth
Radiologic Technologist/Sonographer
CSMRR: 001012016
+237 671459765
B.TECH/HPD in MDIRT
(St. LOUIS UNIHEBS, Univ Buea)
excellence660@gmail.com
MedicalImagingTrainingResourceForMedicalImagTech,
Nurses,MidwivesandMedics,NchanjiNkehKeneth
1
10/23/2020

Presentation outline
Review of ANAPHY of the
female pelvic organs: vagina,
cervix, uterus, fallopian tubes,
ovaries and adjacent adnexa with
cul-de-sac.
Pelvic ultrasound of the
female/related pathologiesMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh
Keneth
210/23/2020

Anatomy/ physiology of the female
pelvis and associated structures
Study expectations:
At the end of this presentation, the students
should be able to:
1. Identify the female reproductive organs
2. Describe their anatomy and relate with physiology
3. Identify structures associated with the female pelvic
organs and their functions
4. Note basic of ultrasound physics and terminologies
5. Identify various scan modes, scan planes
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji
Nkeh Keneth 310/23/2020

Anatomy/ physiology of the female pelvis
and associated structures
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth 4
The female reproductive organs consist of
the :
1. Breasts (mammary glands)
2. The external genitalia (vulva)
3. The vagina
4. Cervix
5. Uterus
6. Fallopian tubes
7. Ovaries
10/23/2020

The Breasts
–BREASTS
NIPPLE
AREOLA
LACTIFEROUS DUCTS
ADIPOSE, GLANDULAR, FIBROUS
TISSUE
COOPER’S LIGAMENTS
Milk secretion and ejection
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and
Medics , Nchanji Nkeh Keneth 510/23/2020

Sagittal cut of the female breast

Breast cancer
Most dangerous malignant cancer
Women need to do breast self exam
regularly
In case of any suspected abnormal
lumps,
May need breast ultrasound ,
screening/diagnostic mammography
and
Breast MRI scan or CT scan
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics
, Nchanji Nkeh Keneth 710/23/2020

Mammograms
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh
Keneth 810/23/2020

Supportive structures of the female pelvis
The bony pelvis supports and protects the
lower abdominal and internal reproductive
organs.
Bony Pelvis Is Composed of 4 bones:
1. Two hip bones.
2. Sacrum.
3. Coccyx
Keneth 910/23/2020

The female pelvic bones
Medical Imaging Training Resource For
Medical Imag Tech, Nurses, Midwives
and Medics , Nchanji Nkeh Keneth 1010/23/2020

Useful measurements to determine the
pelvic volume
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth 1110/23/2020

Significance of the values
When the sum of the measurements is
greater than 23 cm, then there is safe
delivery
When the value is between 22-23 cm,
there will be difficulties in delivery
If less than 20cm, then the pregnancy can
be safely delivered by CS

Pelvic bones/ joints
Notion of true and false pelvis The sacrum, the
ischium, pubic
symphysis have very
significant anatomical
land marks
Keneth 1310/23/2020

Ligaments/muscles/tendons and blood
vessels/ nervous supply
PELVIC DIAPHRAGM
– LEVATOR ANI
– COCCYGEAL
MUSCLES
– DEEP FASCIA
PELVIC FLOOR
MUSCLES
– LEVATOR ANI
– ILLIOCOCCYGEUS
– PUBOCOCCYGEUS,
COCCYGEUS
– PUBORECTALIS,
PUBORECTALIS
– PUBOVAGINALIS
Keneth
1410/23/2020

Ligaments/muscles/tendons and blood vessels/
nervous supply

Hysterosalpingogram
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics ,
Nchanji Nkeh Keneth 1610/23/2020

Ligaments/muscles/tendons and
blood vessels/ nervous supply
Keneth 1710/23/2020

The external genitalia
Collectively,
the external
female
reproductive
organs are
called the
Vulva.
Keneth 1810/23/2020

The vulva
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
Is rounded, soft fullness of
subcutaneous fatty
tissue, prominence over
the symphysis pubis that
forms the anterior
border of the external
reproductive organs.
It is covered with
varying amounts of
pubic hair.
Keneth 1910/23/2020

Vulva
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
The labia Majora are
two rounded, fleshy
folds of tissue that
extend from the mons
pubis to the perineum.
The labia majora
protect the labia
minora, urinary
meatus and vaginal
opening.
Nchanji Nkeh Keneth
2010/23/2020

Vulva cont
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
It is located between the
labia majora, are narrow.
The lateral and anterior
aspects are usually
pigmented.
The inner surfaces are
similar to vaginal mucosa,
pink and mois.
Their rich in vascularity.
Keneth 2110/23/2020

Vulva
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
The term clitoris
comes from a Greek
word meaning key.
Erectile organ similar
to the penis in males.
It’s richly vascular,
highly sensitive to
temperature, touch,
and pressure sensation
Medical Imaging Training Resource For Medical Imag Tech, Nurses,
Midwives and Medics , Nchanji Nkeh Keneth
2210/23/2020

Vulva
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
Is oval-shaped area formed
between the labia minora,
clitoris, and fourchette.
Vestibule contains the
external urethral meatus,
vaginal introitus(entrance to
vagina), and Bartholins glands
(which secrete mucus to
lubricate the vagina).
Keneth
2310/23/2020

Vulva
Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
Is the most posterior
part of the external
female reproductive
organs.
It extends from
fourchette anteriorly to
the anus posteriorly.
And is composed of
fibrous and muscular
tissues that support
pelvic structures.
Keneth 2410/23/2020

Vulva
Keneth 2510/23/2020

Internal female pelvic structures
Vagina
Uterus
Fallopian tubes
Ovaries
Keneth 2610/23/2020

Internal female repro sttres
Vagina
Uterus
Fallopian tubes
Ovaries
It is an elastic fibro-
muscular tube and
membranous tissue
about 8 to 10 cm long.
Lying between the
bladder anteriorly
and the rectum
posteriorly.
Keneth 2710/23/2020

Internal female repro sttres
vagina
The reaction of the vagina is
acidic, the pH is 4.5 that
protects the vagina against
infection.(how is trigomonas vaginalis able to
survive?)
functions
To allow discharge of the
menstrual flow.
As the female organs for
coitus.
To allow passage of the fetus
from the uterus.
The vagina connects the
uterus above with the
vestibule below.
The upper end is blind
and called the vaginal
vault.
The vaginal lining has
multiple folds, or rugae
and muscle layer. These
folds allow the vagina to
stretch considerably
during childbirth.
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
2810/23/2020

The cervix
The lowermost position of the
uterus “neck”.
The length of the cervix is about
2.5 t0 3 cm.
The os, is the opening in the
cervix that runs between the
uterus and vagina.
This part can be a hindrance during
HSG and a cause of infertility in
women
The upper part of the cervix is
marked by internal os and the
lower cervix is marked by the
external os.
Keneth
2910/23/2020

The Isthmus
A narrower transition
zone.
Is between the corpus of
the uterus and cervix.
During late pregnancy,
the isthmus elongates
and is known as the
lower uterine segment.
Keneth 3010/23/2020

The uterus
The uterus is a hollow,
pear shaped muscular
organ.
The uterus measures
about 7.5 X 5 X 2.5 cm
and weighs about 50 –
60 gm.
These are average
measurements for a non
pregnant uterus and can
vary in many situations
Keneth
31
Coronal view of the uterus
10/23/2020

Its normal position is anteverted (rotated forward and slightly antiflexed
(flexed forward)
The uterus is divided into three parts
Nchanji Nkeh Keneth
32
Anteverted uterus (left) and didelphic uterus (right)
10/23/2020

Parts of the uterus
Fundus ( superior
most part)
The body
The isthmus
The cervix
See the previous
slides
Keneth 33
Pregnant uterus
10/23/2020

Parts of the uterus
Fundus (
superior most
part)
The body
The isthmus
The cervix
See the previous
slides
Keneth 3410/23/2020

Abnormal uterus on HSG

Layers of the uterus
Perimetrium
Is the outer peritoneal layer
of serous membrane that
covers most of the uterus.
Laterally, the perimetrium
is continuous with the
broad ligaments on either
side of the uterus.

Perimetrium, Myometrium and Endometrium
Is the middle layer of thick
muscle.
Most of the muscle fibers
are concentrated in the
upper uterus, and their
number diminishes
progressively toward the
cervix.
The myometrium contains
three types of smooth
muscle fiber
1)Longitudinal fibers(outer)
Which are found mostly in
the fundus and are
designed to expel the fetus
efficiently toward the
pelvic outlet during birth.
Keneth 3710/23/2020

2)Middle layer- 8
fibers
These fiber contract
after birth to
compress the blood
vessels that pass
between them to
limit blood loss.
3) inner layer circular fibers
Which form constrictions where the
fallopian tubes enter the uterus and
surround the internal os
Circular fibers prevent reflux of
menstrual blood and tissue into the
fallopian tubes.
Promote normal implantation of the
fertilized ovum by controlling its
entry into the uterus.
And retain the fetus until the
appropriate time of birth
Keneth 3810/23/2020

Is the inner layer of
the uterus.
It is responsive to the
cyclic variations of
estrogen and
progesterone during
the female
reproductive cycle
every month.
The two or three
layers of the
endometrium are:
*Compact layer
*The basal layer
*The functional
or Sponge layer this
layer is shed during
each menstrual period
and after child birth in
the lochia

Functions of the uterus
Menstruation ----the
uterus sloughs off the
endometrium.
Pregnancy ---the
uterus supports fetus
and allows the fetus to
grow.
Labor and birth--
-the uterine
muscles contract
and the cervix
dilates during
labor to expel the
fetus
Keneth 4010/23/2020

The fallopian tubes
The two tubes extend
from the cornu of the
uterus to the ovary.
They run in the upper
free border of the
broad ligament.
Length 8 to 14 cm
average 10 cm
Its divided into 4
parts.

FT- intestitial part
Which runs into
uterine cavity,
passes through the
myometrium
between the
fundus and body
of the uterus.
About 1-2cm in
length.
Keneth 4210/23/2020

FT- isthmus
Which is the
narrow part of
the tube adjacent
to the uterus.
Straight and
cord like , about
2 – 3 cm in
length

FT- ampulla
Which is the
widest part;
about 5 cm in
length.
Fertilization
occurs in the
ampulla.
Keneth 4410/23/2020

FT- infundibulum
It is funnel or
trumpet shaped.
Fimbriae are
fingerlike
processes, one of
these is longer
than the other and
adherent to the
ovary.
The fimbriae
become swollen
almost erectile at
ovulation.Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji

Functions of the FT
Gamete transport (ovum pickup, ovum transport,
sperm transport).
Final maturation of gamete post ovulate oocyte
maturation, sperm capicitation.
Fluid environment for early embryonic
development.
Transport of fertilized and unfertilized ovum
to the uterus.

Ovaries
Oval solid structure, 1.5 cm in thickness, 2.5
cm in width and 3.5 cm in length
respectively. Each weighs about 4–8 gm.
Target point for teratomas, etc
Contains follicular cysts, corpus luteum cyst
of pregnancy and action site for FSH and
LH
Ovary is located on each side of the uterus,
below and behind the uterine tubes
4710/23/2020

Sttre of the ovary
Cortex
Medulla
Hilum
Keneth 4810/23/2020

ADNEXAE
10/23/2020
and Medics , Nchanji Nkeh Keneth 49

10/23/2020

Functions: Production of ova and Secrete estrogen &
progesterone.
Keneth 5510/23/2020

ovulation
Keneth
5610/23/2020

Conception
MATURATION OF OVARIAN FOLLICLE
OVULATION
CORPUS LUTEUM
NEUROHUMORAL RESPONSE
– HYPOTHALMUS RELEASES GONADATROPIN-
RELEASING HORMONE TO PITUITARY FROM
RESPONES FROM CNS
– ANTERIOR PITUITARY THEN SECRETES FSH
AND LH

The 4 phases of the Menstrual cycle
FEMALE REPRODUCTIVE CYCLE
– OVARIAN CYCLE
FOLLICULAR PHASE
LUTEAL PHASE
FEMALE HORMONES
– ESTROGEN
– PROGESTERONE
– PROSTAGLANDINS
UTERINE CYCLE (MENSTRUAL
Keneth 5810/23/2020

A 28 day cycle
5910/23/2020

Process of ovulation
Review of conception and fetal
development
CELLULAR DIVISION
– MITOSIS
– MEIOSIS
OOGENESIS
SPERMATOGENESIS
PRE-FERTILIZATION
– CAPACIATION
– ACROSOMAL REACTION
– FERTILIZATION
6010/23/2020

Conception/ fetal develp cont
 CELLULAR MULTIPLICATION
 CLEAVAGE
 MORULA
 BLASTOCYST
 TROPHOBLAST
 IMPLANTATION
 CHANGES IN ENDOMETRIUM
DECIDUA CAPSULARIS
DECIDUA BASALIS
DICIDUA VERA
Keneth 6110/23/2020

Survival of the fittest
Keneth 6210/23/2020

Oogenesis and spermatogenesis
Keneth
6310/23/2020

Keneth 6410/23/2020

Note the 3 primary germ cells
CELLULAR DIFFERENTIATION
– THREE PRIMARY GERM LAYERS
ECTODERM
MESODERM
ENDODERM
EMBRYONIC MEMBRANES
– AMNION
– CHORION

Fetal vessels

Further maturation of the endoderm
Keneth 6810/23/2020

Stages of development
Keneth 6910/23/2020

Stages of labor
stage 1
First stage
– Begins with onset of labor pains
– Lasts until cervix is fully dilated
– Toward the end of the stage, the amniotic sac
often ruptures.

Stage 2
Second stage
– Begins as the head descends to enter birth
canal
– Fetus will undergo several position changes.
Internal rotation
Extension
Rotation to the side
Movement of the shoulders
Second stage (cont’d)
– Contractions are more intense and frequent.
– The cervix becomes fully dilated.
– Concluded when the newborn is fully delivered

Third stage of labor
– Placenta is expelled.
– Uterine contractions squeeze shut the exposed
blood vessels.
Keneth 7210/23/2020

Maternal and fetal response to labor
Maternal response
– Increase in:
Workload of the heart
Blood pressure, pulse, and cardiac output
Breathing rate
WBC production
Fetal response
– Decrease in the amount of oxygen and nutrients
– Insufficient removal of waste
– Decreased fetal heart rate
– Fetal acidosis

Preparing for delivery
Birthing positions
–Standing birth
Fetal head is moved away from
the sacral area.
–Semi-Fowler’s position
Keneth 7410/23/2020

Birth positions
7510/23/2020

Birthing positions (cont’d)
Kneeling birth
Fetal head is moved away from the sacrum.
Side-lying position
Fewer perineal tears
Keneth 7610/23/2020

Assisting In delivery
Control delivery.
Support the head as it
emerges.
Check for nuchal cord.
Clear the airway by
suctioning with a bulb
syringe.
7710/23/2020

Gently guide the
head downward
so the upper
shoulder can
deliver.
Gently guide the
head upward to
allow delivery of
the lower
shoulder

Once delivered,
maintain at the
same level as
the vagina.
Wipe blood or
mucus from the
newborn’s nose
and mouth with
sterile gauze.

Dry the newborn with sterile towels, and
wrap in a dry blanket.
Record the time of birth why?
8010/23/2020

Nchanji Nkeh Keneth
8110/23/2020

Can only treat the
woman directly
Determine
gestational
age of fetus if
possible.
Transport a
pregnant woman
on left side if no
spinal injury is
suspected. Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives
Management of pregnant trauma patient
10/23/2020

Success Hardwork Play Keep your Mouth shut
A = X + Y + Z
Albert Einstein Equation of Life in 4D.
“Action is the foundational key to all success.“
"The successful person has the habit of doing the
things failures don't like to do."
10/23/2020

Beri wi ba’a ghor
10/23/2020

Part C
Lecture 3
Pelvic ultrasound
Nchanji Nkeh Keneth
8710/23/2020

Introduction
Pelvic ultrasound plays a very vital role
in gynecology
It is usually done in conjuction with
obstetric ultrasound
Thorough knowledge of the female
pelvic anatomy/ physiology is
paramount.
It concentrates primarily on the uterus,
ovaries, FT while scanning the adjacent
adnexae
Keneth 8910/23/2020

Patient preparation
It usually requires a full urinary bladder for
trans abdominal scan.
The patient may also need enema
cleansing of the large bowel
The full Ub serves as an acoustic window
for the uterus and other structures

Indications for pelvic US/clinical features
The indications include but are not limited
to the following:
1. Follow up of a known disease
2. Pelvic pain
3. Abnormalities with menstruation
4. Lower abdominal tenderness,
5. Confirmation of PID
6. Suspected female reproductive tract
obstruction

Step by step approach
1 The UTERUS
It is a pear-shape
muscular organ
Measures about 7.5cm
in length, 5cm in width
and about 2.5cm in
thickness
Please visit lecture 1 for
more details

Hysterectomy images

Uterus cont
The uterus is
surrounded by 8
ligaments
Some common
terms to describe
the uterus
position are:
Retroverted
Retroflexed
Anterveted
anteflexed

Sonographic characteristics
The uterus is seen as a homogeneous structure lying posterior to
the distended bladder. In the sagittal plane, the vagina is
identified as three parallel echogenic lines opening into the
cervix. The cervix is a slightly bulbous and smoothly
marginated opening into the body and fundus. The central
endometrial canal is represented as a hyperechoic line. On
occasion, the canal can be distended by fluid (blood or pus).
Intra-cavitary scanning provides superior detail of the uterine
tissue and better describes the following uterine changes that
occur in different phases of the menstrual cycle.

Uterine lining thickness at diff phases of the
menstrual cycle

Normal uterus variants and
abnormalities

Disorders of the uterus
Uterine fibroid
Leiomyoma are the most common benign neoplasms
of the uterus. They are found in 20 to 40 percent of
women over 30 to 35 yrs of age. They are also known
as fibroids, myomas and fibroleiomyomas because
they are composed of varying amounts of smooth
muscle and stromal tissue. Leiomyomas are usually
multiple but do occur as solitary lesions in less than
2 percent of patients.
Leiomyoma may be situated under the serosa
(subserous), within the myometrium (intramural or
interstitial) or under the mucosa or endometrium
(submucous or subendometrial). Intra mural
leiomyomas are the most common; submucosal are
the least frequent.
Keneth
10110/23/2020

They are most common in the body and fundus of
the uterus. In 3 percent of cases, a leiomyoma is
found in the uterine cervix; at times, a tumor may
occur in the broad ligament, where it mimics an
adnexal neoplasm.
Because they may grow under the influence of
oestrogen, leiomyomas may increase in size during
pregnancy and may become smaller following
menopause. They vary in size from a few cm to massive
tumors.

They may undergo malignant changes. A
leiomyosarcoma develops in a pre-existing
leiomyoma in approximately 0.2 percent of cases.
Enlargement of a fibroid in a postmenopausal
woman should raise the possibility of malignant
degeneration. It is important to remember that it is
usually impossible to definitely differentiate a benign
fibroid from a leiomyosarcoma either clinically or
sonographically.
Leiomyomas occasionally cause infertility by
deforming the isthmic portion of the fallopian tube
and obstructing the passage of the ovum.

Various types of fibroids based on their
location
10410/23/2020
and Medics , Nchanji Nkeh Keneth

Clinical findings/ sonographic appearnce
Patients with leiomyomas
are usually
asymptomatic, though
they can present with
menstrual irregularities,
abdominal or pelvic pain,
pressure symptoms of the
urinary bladder and GIT,
palpable pelvic or
pelvoabdominal mass or
infertility or prolonged
labor.
Sonographically,
A hypoechoic mass is
usually seen
The size and shape of
the uterus varies
There may be
calcifications

Fibroids in pregnanacy

Disorders
2. POLYPS
They arise from the
endometrium,
echogenic and are
small in size.
Keneth 10910/23/2020

3.NEBOTHIAN cysts
Nabothian cysts are benign cystic
lesions of the endocervix that are
frequently multiple and range
from 2 to 3 mm in diameter. The
cervix of the uterus contains
glands lined by mucin secreting
cells. When the duct is obstructed
or stenosed because of
inflammation from chronic
cervicitis, retention of mucus
results in cystic dilation of the
gland and the development of a
Nabothian cyst.
The patient is
generally
asymptomatic. There
may be associated
signs and symptoms
of cervicitis such as
vaginal discharge,
dyspareunia, urinary
frequency, urgency or
metrorrhagia
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth 111
Clinical findings
10/23/2020

Note the posterior
enhancements

4. Cervical carcinoma
Carcinoma of the cervix is the most
common malignant gynecologic
neoplasm in women. It occurs
predominantly between 45 and 55 yrs of
age but can affect younger patients. The
exact etiology of carcinoma of the
cervix is uncertain. Lower
socioeconomic status, early sexual
exposure, herpes virus type 2 and
multiple sexual partners have been
considered as contributing factors.
11310/23/2020

Clinical findings
Although patients may be asymptomatic,
some present with abnormal uterine
bleeding, vaginal discharge, anorexia (loss
of appetite), anemia, weight loss, pelvic
pain, cervical ulceration,
dyspareunia(painful sexual intercourse)
etc.

Sonographic properties
Most commonly a
mass posterior to the
urinary bladder that is
usually hypoechoic,
but may be
inhomogeneous

5.Female genital tract obstruction
An obstruction can occur
anywhere in the female
genital tract. Cause of
obstruction include
imperforate hymen, vaginal
membrane, vaginal cervical
stenosis or atresia, post
menopausal atrophy, vaginal
fibroma, radiotherapy for
carcinoma of the cervix.
Clinical findings
Pubertal age females
presenting with
amenorrhea, pelvic
pain, abdominal
distention, palpable
pelvic mass and urinary
tract obstruction.
Keneth 11610/23/2020

Sonographic features
Most commonly an ovoid or
pear-shaped sonolucent midline
mass with posterior acoustic
enhancement situated behind
the urinary bladder
Low-level internal echoes may
be scattered throughout the
mass or produce an echogenic-
anechoic level The uterus may
be displaced superiorly.
The lesion can be lobulated or
tubular if there is extension of
the hemorrhage into the cervix
and uterus.
Keneth 11710/23/2020

The fallopian tubes
The fallopian tubes are not usually visualized
sonograically because of their extremely small
diameter, however, a fallopian tube distended
with pus (pyosalpinx) or fluid (hydrosalpinx) can
be readily seen. Conventional transabdominal
scanning demonstrates a distended tube as a
sonoluccent cylindrical structure lying in a
transverse plane in the adnexal area. An
intracavitaryprobe often may even show it
folding on itself in the adnexal region.
11810/23/2020

Disorders
1.Hydrosalpinx
Hydrosalpinx
refers to the
dilatation of the
fallopian tube
with fluid; if
pus, then
pyosalpinx
11910/23/2020

10/23/2020

OVARIES AND DISORDERS
10/23/2020

The OVARIES and disorders
The bilateral ovaries are seen as oblong or
almond shaped structures lying in the adnexal
regions . They usually lie medial to the iliac
vessels and lateral to the ureters. The position of
each ovary is highly variable and may change
due to pregnancy, surgical procedures, or
displacement by adjacent structures. The
ovaries are well encapsulated and exhibit a
smooth medium echogenicity. They usually
contain thin walled sonolucent follicles that
generally are not more than 2.5 cm in diameter.

The size of
the ovary
reduces in
post
menopausal
women

Disorders
1.Follicular cysts
When a mature follicle
fails to involute or
ovulate, it ruptures and
closes off immediately,
resulting in retention of
the fluid and the
formation of a follicular
cyst.
Clinical features
Although most patients
are asymptomatic, some
present with pelvic pain
due to hemorrhage into
the cyst; rupture of the
cyst; or torsion of the
ovary containing the cyst.
Occasionally, abnormal
uterine bleeding or an
enlarged tender ovary
may develop.

Most commonly
an anechoic
ovarian mass
with thin smooth
walls.
Image
Keneth 12510/23/2020

Hemorrhagic ovarian cyst
Keneth 12610/23/2020

Corpus luteum cyst

3. Polycystic ovarian disease
Polycystic ovarian disease (PCOD)
(Stein−leventhal syndrome) is a complex
endocrinologic disorder that causes
chronic anovulation.
It results from low levels of FSH and high
level of LH !!!!!
Usually bilateral
Keneth 12810/23/2020

PCOD

4.DERMOID cysts
They are benign tumors that arise from
germ cells of the ovary. Composed of
tissue originating from all three germ
cell layers (ectoderm (covers the body
of the embryo, it produces the epidermis
and the NS of the adult), endoderm( one
of the tissue layers of the embryo wh
eventually produces the GIT) and
mesoderm( eventually produces many
organs of the adult such as the brain,
muscles, will give rise to body
systems,etc), 13010/23/2020

Dermoids contain variable amounts of
fat, hair, skin and teeth. Although they
can occur at any age, the tumor most
often is found in the reproductive age
group (20 to 40 yrs of age).
Dermoids account for 10 to 15 percent
of all ovarian neoplasm (50 percent of
all ovarian neoplasm in children). They
are usually unilateral, but can be
bilateral in 25 percent of cases and
multiple in the same ovary.

Multiple nodules in the mass or
predominantly solid components in a
childhood tumor should suggest the
possibility of malignancy. Ascites, metastatic
liver disease, lympadenopathy,
hydronephrosis
and mesenteric as well as omental involvement
may be associated with malignant degeneration,
which develops in 2 to 4 percent of cases.

Sonographic appearance
It consists of a complex mass containing
fluid and hyperechoic solid tissue
associated with posterior acoustic
shadowing. The hyperechoic component
may result from sebum, hair and at times
from teeth, calcification or ossification.

10/23/2020

Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an
acute or chronic process in which
infection spreads to the pelvis in
ascending fashion, most commonly via
the vagina but also by direct spread
from pelvic surgery, diverticulitis,
ruptured appendicular abscess, post-
partum sepsis or the hematogenous
route. An intrauterine device may
predispose to the development of PID
at the time of insertion, (or re-
insertion), or if it perforates. 13710/23/2020

138
The three stages of PID are hyperemia,
frank salgingitis and tubo-ovarian
abscess. In the 1st stage, which is
characterized by mild hyperemia, free
effusion and exudates, the ultrasound
exam may be entirely normal. The 2nd
stage of salpingitis consists of
enlarged ovaries with no evidence of
abcess. In the 3rd stage, the enlarged
ovaries contain abcesses of varying
size, which may appear in the pouch of
douglas.10/23/2020

Clinical findings
Patients may remain
asymptomatic or
present with a foul-
smelling vaginal
discharge, fever,
pelvic discomfort, pain
or tenderness, a
palpable pelvic mass
or abnormal bleeding.
Endometrial
echoes may be
more
prominent than
normal
13910/23/2020

PID
note the prominent endometrial echoes in the images
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5.Endometriosis
It is the presence of active functioning
endometrial tissue outside its normal site in
the lining of the uterine cavity. The
condition affects women in the child-bearing
age and can be diffuse or focal. The ovary is
the most frequent site of involvement, which
is usually bilateral. Other areas affected by
endometriosis include the pouch of
Douglas, round ligaments, urinary bladder,
broad ligament posterior surface of the
uterus, colon etc.
14110/23/2020

The exact etiology of endometriosis is
unknown. Postulated causes include;
Ectopic endometrial tissue is
transplanted on pelvic structures from
the uterus via the fallopian tubes by
retrograde menstrual blood flow.
Endometrial tissue is directly implanted
at the time of surgery or as a
combination of the above mechanisms.

Endometrioma or Endometriotic cyst of ovary or
Chocolate cyst of the ovary

REFERENCES
10/23/2020

FUNDAMENTALS OF OBSTETRIC AND
GYNAECOLOGICAL ULTRASOUND
NURSING/MIDWIFERY L400 STUDENTS OF ST. LOUIS UNIHEBS
2015/2016 ACADEMIC YEAR
PART A
Brief Review Of Anatomy And Physiology Of The
Female Pelvic Organs
145
Nchanji NKEH KENETH
kennchanji@yahoo.com
Radiology Dept
Keneth
WITH MATERIALS FROM AIUM, UKAS, WHO MANUAL OF DIAGNOSTIC ULTRASOUND
10/23/2020

10/23/2020

References
10/23/2020
Medical Imaging Training Resource
For Medical Imag Tech, Nurses,
Midwives and Medics , Nchanji Nkeh
Keneth 147

Pelvic ultrasound radiology training resource nchanji nkeh keneth

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