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3.3female and Male Genital Tract 2018
3.3female and Male Genital Tract 2018
MAY 2018
UTERUS
Smoothly contoured pear shaped in postpubertal women
Cigar shaped in prepubertal and infants
Endometrium is distinctly more echogenic than the myometrium
Maximum uterine dimensions in adult women: 9 cm (length), 6 cm
(width), 4 cm (AP diameter).
Atrophies to 6 x 2 x 2 cm following menopause
Positions of the uterus:
Anteverted (most common) – tilted forward
Retroverted – tilted backward toward the sacrum
Anteflexed – folded anteriorly
Retroflexed – folded posteriorly
MULTIPLE LEIOMYOMAS
MRI
A midsagittal T2WI of the pelvis demonstrates multiple
leiomyomas (L), which greatly enlarge and distort the uterus.
The endometrial cavity (e) of the uterus and the cervix (c) are
clearly demonstrated. B, bladder; V, vagina.
LEIOMYOMAS (FIBROIDS)
Common benign smooth muscle tumors of the myometrium
Virtually always multiple
May be completely within the myometrium, subserosal, or
submucosal
Uncomplicated leiomyomas may be isoechoic, hypoechoic, or
hyperechoic compared to normal myometrium.
May undergo atrophy, internal fibrosis, and calcification
correspondingly, they involute with menopause.
The tumors are responsive to female hormones and pregnancy.
Plain film radiograph:
Popcorn pattern of calcification is characteristic and
definitive
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
ADENOMYOSIS
Benign disease of the uterus characterized by the presence of
ectopic endometrial glands and stroma within the myometrium,
eliciting surrounding myometrial hypertrophy.
Presentation: dysmenorrhea or menorrhagia
US: no definite nodule is seen.
ADNEXA
Refers to the ovaries, fallopian tubes, broad ligament, ovarian and k
OVARIES
US demonstrates the ovaries as oval soft tissue structures with
multiple cystic follicles and show characteristic morphological
changes during menstrual cycle
Normal follicles range up to 15 mm in size, dominant follicle
may be 30 mm in diameter
22 cc – maximum ovarian volume (adult)
6 cc – maximum ovarian volume for postmenopausal
women
FALLOPIAN TUBES FUNCTIONAL OVARIAN CYST
Not visualized on US unless enlarged Most common ovarian mass
BROAD LIGAMENT Normal: small cyst up to 3.0cm
Clearly visualized when outlined by pelvic fluid Pathologic: follicular cyst up to 20cm
May rupture or undergo torsion
Round, smooth, usually unilocular ovarian cyst that resolves in 1 or
2 menstrual cycles
Anechoic thin–walled cysts (simple cysts) that fail to resolve after 2
menstrual cycles maybe neoplasms (cystadenomas or benign
cystic teratomas)
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
Acute:
US demonstrates a complex ill-defined adnexal mass that often
includes a dilated, pus-filled fallopian tube, swollen ovary, and
adhesions to adjacent structures.
Echogenic, purulent, fluid is usually present in the cul-de-sac.
Chronic:
Manifest as hydrosalpinx or peritoneal inclusion cyst
HYDROSALPINX
Can produce large complex cystic mass
US:
Thin- walled or thick-walled tubular mass that is commonly
HEMORRHAGIC OVARIAN CYSTS elongated and folded on itself
Result from hemorrhage into a follicle or the corpus luteum. Commonly caused by PID or endometriosis
S/S: abrupt onset of pelvic pain, pelvic mass
Common in premenopausal unless they are taking hormone-
replacement therapy
Findings:
Cystic mass with internal echoes
Accentuated through – transmission reflects its cystic nature
Wall thickness is variable (2-20mm)
Blood flow in the wall is commonly prominent
Internal echogenicity depends upon the physical state of the
hemorrhage
The cyst may appear solid, but color flow US show no internal
blood vessels
Hysterosalpingography
Retroflexed uterus (U), with the fundus (f) directed posteriorly
and inferiorly.
Fine internal echoes with a fishnet appearance of thin, linear, fibrous strands (red The left fallopian tube is occluded at the isthmus (black arrow).
arrows) characteristic of hemorrhage
The right fallopian tube (open arrow) is massively dilated at its
Color doppler demonstrates lack of internal blood flow
distal end, forming a hydrosalpinx (HS).
Occlusion of the right fallopian tube is confirmed by the
absence of peritoneal spill. The curved arrow indicates the
POST-MENOPAUSAL OVARIAN CYSTS
cervical cannula.
Benign serous inclusion cysts
US features:
Small size less than 5 cm
Smooth thin walls of uniform thickness less than 3 mm
Anechoic fluid contents
Absence of septation, nodules or any soft tissue component
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
ENDOMETRIOSIS
Occurrence of aberrant functional endometrial tissue outside the
uterus
Common in ages 25-35 yrs and present with infertility and chronic
pelvic pain
Tiny implants (1-2mm) of endometrial tissue on the peritoneum that
are not visualized by US.
Larger deposits form cystic masses filled with old, echogenic blood
“Chocolate Cyst” or endometrioma
Endometriomas: wide range of appearance as single, or OVARIAN MALIGNANCY
multiple, adnexal masses with diffuse low-level internal echoes. A solid component to an ovarian lesion is the most significant
predictor of malignancy;
Irregular thick wall and septa > 3mm;
Doppler demonstration of central blood flow within a solid
component.
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
SCROTUM EPIDIDYMIS
Tunica vaginalis Highly convoluted tubule that is tightly applied to the posterior
A peritoneal membrane that forms a closed serous sac that aspect of the testis.
covers the medial, anterior, and lateral aspects of the testis and
the lateral aspect of the epididymis. Head of the epididymis (globus major)
This space normally contains 1 to 2 mL of fluid. 7- to 8-mm-diameter
Excessive fluid in this space is termed a hydrocele. Superior portion of the epididymis adjacent to the superior
Spermatic cord pole of the testes.
Formed at the internal inguinal ring, courses through the Body of the epididymis
inguinal canal and abdominal wall, and suspends the testes in 1 to 2 mm in diameter
the scrotum. Courses caudally along the posterolateral testis
Consists of the ductus deferens; the testicular, deferential, and Tail (globus minor)
external spermatic arteries; the pampiniform plexus of veins; The pointed lower extremity of the epididymis at the lower pole
lymphatic vessels; and the covering cremaster muscle. of the testis.
Enlargement of the pampiniform plexus of veins is termed
a varicocele. RADIOLOGY OF THE EPIDIDYMIS
Ultrasound
Head of the epididymis is seen resting on the upper pole
posteriorly
Body of the epididymis is seen posterolateral to the testis
Spermatic cord is medial to the epididymis
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
PROSTATE
Normal US Anatomy The central and peripheral zones are nearly equal in
A rounded organ at the base of the bladder echogenicity and are usually distinguished mainly by position.
Divided into three glandular zones surrounding the urethra yields uniform, low level echoes
Peripheral zone It is useful to describe the gland on US as having peripheral
Approximately 70% of the prostate tissue
zone and an inner gland comprised of central and transitional
Most prostate cancers (70%) arise in this zone zones.
Transitional zone
The anterior fibromuscular stroma is seen as hypoechoic area
Consists of two small areas of periurethral glandular
at the anterior superior aspect of the gland.
tissue - site of benign prostatic hypertrophy
Ultrasound measurements are used to calculate the volume of
Central zone
the prostate gland using the formula width x height x length
Consists of the glandular tissue at the base of the
x 0.52.
prostate, through which course the ducts of the vas
deferens and seminal vesicles and the ejaculatory
ducts
With aging, the transition zone hypertrophies and the central zone
atrophies.
70% of prostatic cancers arise in the peripheral zone of the gland.
Benign prostatic hypertrophy – affects the transition zone in the
central gland.
Major indication for transrectal US of the prostate gland
To guide needle biopsy for diagnosis of prostate cancer
Additional indications for US:
MRI
Detection of abscess or infertility with suspicion of obstruction
Excellent method of imaging the prostate.
of the ejaculatory ducts or atresia of the seminal vesicles
Zonal anatomy is seen on the T2-weighted image.
Examination of the posterior urethra
The peripheral zone is of uniformly high intensity and contrasts
with the intermediate signal intensity of the transitional and
RADIOLOGY OF THE PROSTATE
central zones.
On transabdominal US through the distended bladder
Seminal vesicles are seen posterior to the prostate and bladder
Prostate is seen as a rounded organ at the base of the bladder.
on axial and sagittal images.
Enlargement of the prostate elevates the bladder base
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“Vitanda est improba siren desidia”
CD B: RADIO | FEMALE AND MALE GENITAL TRACT
MAY 2018
CT scan
Gland is seen as a round structure of soft-tissue density inferior
to the bladder.
Poor for assessment of prostate zonal anatomy and pathology
With adjusted window settings:
Central zone appears hyperdense between 40-60HU
Peripheral zone appears hypodense between 10-25HU
Useful staging metastatic spread
Seminal vesicles are convoluted structures above the prostate
between bladder and rectum.
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“Vitanda est improba siren desidia”