Successfully reported this slideshow.
Your SlideShare is downloading. ×

Uterine Myoma, Endometriosis, Endometrial Ca and.pptx

Upcoming SlideShare
Managing adenomyosis
Managing adenomyosis
Loading in …3

Check these out next

1 of 31 Ad

More Related Content

Similar to Uterine Myoma, Endometriosis, Endometrial Ca and.pptx (20)

Recently uploaded (20)


Uterine Myoma, Endometriosis, Endometrial Ca and.pptx

  1. 1. Uterine Myoma, Endometriosis, Endometrial Ca and Cervical CA on Ultrasound Abel Girma (RR)
  2. 2. Myomas: ▪ Uterine leiomyomas, also known as uterine fibroids. ▪ ~25% of women of reproductive age and over 70% of women by menopause. ▪ Commonly Incidental ▪ Dx is rarely difficult
  3. 3. Typical Sonographic Features ▪ Round ▪ Heterogenous ▪ Hypoechoic ▪ Sound attenuating ▪ Contour Deforming ▪ Often calcified ▪ Usually Multiple
  4. 4. Intramural Myoma • Surrounded By Myometrium • Often have a submucosal or Subserosal component • Describe the amount of each component • To Plan surgical approach
  5. 5. Transmural Myoma : From Serosa to submucosa
  6. 6. Submucous Myoma ▪ Surrounded by endometrium ▪ Surface area of the myoma that is surrounded by endometrium should be described ▪ Associated with reproductive Problems ▪ Prone to torsion if they are Pedunculated
  7. 7. Myoma Prolapsing through Cervix
  8. 8. Location of Myoma : SHG
  9. 9. Location of Myoma : SHG
  10. 10. Subserosal Myoma
  11. 11. Subserosal Pedunculated Myoma ▪ The Pedicle diameter < 50 % of the Myoma ▪ May not be seenTransvaginally
  12. 12. Secondary Changes in Myomas ▪ Degeneration : Hyaline, Calcific, Cystic, Fatty, Red, Sarcomatous ▪ Necrosis ▪ Hemorrhage ▪ Infection
  13. 13. Adenomyoma vs Leiomyoma
  14. 14. Endometrial CA ▪ considered the most common gynecological malignancy. It frequently presents with vaginal bleeding. ▪ peak incidence at around the 6th decade, though 12% of cases present in premenopausal women. ▪ risk factors for endometrial carcinoma are anything that leads to increased estrogen exposure
  15. 15. Ultrasound Features ▪ Endometrial carcinoma usually appears as thickening of the endometrium though may appear as a polypoid mass. ▪ premenopausal: normal endometrial thickness varies through the menstrual cycle ▪ diagnosing abnormally thickened endometrium depends on knowing what the patient's point in the menstrual cycle ▪ postmenopausal: >5 mm is thickened (>8 mm if on hormone replacement therapy or tamoxifen) ▪ Sonographic features are non-specific and endometrial thickening can also be due to benign proliferation, endometrial hyperplasia, or polyps.
  16. 16. Endometrial Thickness
  17. 17. Ultrasound features that are suggestive of endometrial carcinoma rather than hyperplasia include ▪ heterogeneous and irregular endometrial thickening ▪ polypoid mass lesion ▪ intrauterine fluid collection ▪ frank myometrial invasion – Disruption of a subendometrial halo on ultrasound may be suggestive of myometrial involvement
  18. 18. Endometrial Adenocarcinoma
  19. 19. SHG
  20. 20. Endometriosis… ▪ Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infertility. ▪ Endometriosis is a chronic gynecologic disorder that is characterized by the growth of endometrial tissue outside the uterine cavity, primarily as implants in the pelvic peritoneum and ovaries , ▪ Ovarian lesions are characterized by cysts with hemorrhagic content.
  21. 21. Drawings of the female pelvic anatomy in the axial (a) and sagittal (b) planes show the locations of multiple endometriotic lesions.The round black lesion in the right ovary in a represents an endometrioma.The lesions with irregular margins are indicative of deeply infiltrating endometriosis
  22. 22. Trans vaginal Ultrasound after Bowel Preparation: ▪ Bowel preparation is used to eliminate fecal content and gas in the rectosigmoid colon. ▪ It includes a mild laxative administered in two oral doses (at 8:00 am and 2:00 pm) the day before the scheduled transvaginal US examination, a low-residue diet for 24 hours before the examination.
  23. 23. Dynamic Scanning… ▪ Pelvic adhesions can be evaluated by gently moving the transducer back and forth against the cervix during abdominal palpation to assess whether the uterus, ovaries, and bowel loops slide freely over each other
  24. 24. Limitations of Transvaginal US ▪ The main limitation of transvaginal US is the restricted field of view. It is difficult to visualize lesions located outside the pelvis. ▪ Other common conditions that may impair lesion visualization are large ovarian cysts, subserosal leiomyomas, and acute retroflexion of the uterus. ▪ In addition, severe pelvic adhesions and other distortions of the pelvic anatomy may limit transvaginal US evaluation of the pelvic region.
  25. 25. Bladder endometriosis in a 28-year-old woman. ▪ (a) Sagittal transvaginal US image shows a hypoechoic nodule (N) attached to the bladder wall and hypoechoic endometrial tissue infiltrating the detrusor muscle (arrow). ▪ (b) Magnified cystoscopic view of the same lesion (arrows) shows bluish spots (*) that represent tiny hemorrhagic foci.
  26. 26. Endometriosis of the anterior pelvic compartment in a 32-year-old woman (a) Sagittal oblique transvaginal US image shows a hypoechoic endometriotic lesion (arrowheads) with irregular and ill-defined margins that has infiltrated the peritoneum near the insertion of the left round ligament. (b) (b) Laparoscopic view depicts vesicouterine peritoneal infiltration (arrows) near the left round ligament (LRL).
  27. 27. Paracervical endometriosis with ureteral stenosis in a 35-year-old woman with infertility. (a, b) Sagittal oblique transvaginal US images show a large heterogeneous paracervical mass (ovoid dotted line) representative of an endometriotic lesion that has surrounded the dilated left ureter (arrowheads).The lesion is best depicted in a, and the ureteral dilatation, in b. (c)Transabdominal US image of the left kidney demonstrates moderate hydronephrosis.
  28. 28. Endometrioma Transvaginal US image obtained in a 26-year-old woman with pelvic pain shows an endometrioma with a hyperechoic peripheral nodule (arrow) in the right ovary. Transvaginal US image obtained in a 28-year-old woman shows an endometrioma with a fluid-fluid level (arrow) in the left ovary. The lighter area to the left of the arrow represents more recent hemorrhage, a finding made more recognizable by the sepia colorization.
  29. 29. Cervical CA ▪ Reading Assignment
  30. 30. Thank You