Imaging of the internal female reproductive organs (including the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy, ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy, and fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy) is indicated to diagnose common gynecologic complaints, most commonly in cases of abnormal bleeding, pelvic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, and to evaluate masses, congenital Congenital Chorioretinitis anomalies, and infertility Infertility Infertility is the inability to conceive in the context of regular intercourse. The most common causes of infertility in women are related to ovulatory dysfunction or tubal obstruction, whereas, in men, abnormal sperm is a common cause. Infertility. Ultrasound is almost always the 1st-line imaging modality of choice, whereas MRI is typically reserved for complicated or indeterminate cases as a follow-up. Computed tomography is almost never used for primary gynecologic assessments. Fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy are not visible on either ultrasound or MRI if they are normal. The best way to assess tubal patency is by using hysterosalpingography Hysterosalpingography Radiography of the uterus and fallopian tubes after the injection of a contrast medium. Congenital Malformations of the Female Reproductive System, a fluoroscopic exam in which a dye is injected into the uterine cavity, followed by the study of its flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure through the fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy.
Last updated: 20 Dec, 2021
Prior to the interpretation of any image, the physician should take certain preparatory steps. The same systematic approach should be followed every time:
Ultrasound (i.e., sonography Sonography The visualization of deep structures of the body by recording the reflections or echoes of ultrasonic pulses directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1. 6 to 10 megahertz. Diagnostic Procedures in Gynecology) is almost always the imaging modality of choice when evaluating the internal female reproductive organs. Indications include:
Transvaginal ultrasound Transvaginal Ultrasound Obstetric Imaging (TVUS):
Transabdominal ultrasound (TAUS):
Depth and gain:
Transvaginal ultrasound
Transvaginal Ultrasound
Obstetric Imaging showing a
sagittal
Sagittal
Computed Tomography (CT) view of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy:
The majority of the structure represents normal and homogenous myometrium. The
endometrium
Endometrium
The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo.
Embryoblast and Trophoblast Development is the more
hyperechoic
Hyperechoic
A structure that produces a high-amplitude echo (lighter grays and white)
Ultrasound (Sonography) (lighter) strip down the middle. Endometrial thickness is measured near the
fundus
Fundus
The superior portion of the body of the stomach above the level of the cardiac notch.
Stomach: Anatomy and is noted to be 7.1
mm
MM
Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies.
Multiple Myeloma, which is normal in reproductive-aged women.
Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) ultrasound:
Saline infusion sonogram Sonogram Chorioretinitis ( SIS SIS Infertility) (sometimes called a sonohysterogram):
3-dimensional (3D) sonography Sonography The visualization of deep structures of the body by recording the reflections or echoes of ultrasonic pulses directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1. 6 to 10 megahertz. Diagnostic Procedures in Gynecology:
Saline infusion
sonogram
Sonogram
Chorioretinitis (
SIS
SIS
Infertility):
Sterile
Sterile
Basic Procedures saline instilled into the uterine cavity is
anechoic
Anechoic
A structure that produces no echo at all (looks completely black)
Ultrasound (Sonography) (visible as the dark central portion of the image); it delineates the shape of the endometrial cavity. This image shows a normal
endometrium
Endometrium
The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo.
Embryoblast and Trophoblast Development (
hyperechoic
Hyperechoic
A structure that produces a high-amplitude echo (lighter grays and white)
Ultrasound (Sonography)/brighter band around the cavity) without any focal changes. The
endometrium
Endometrium
The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo.
Embryoblast and Trophoblast Development is surrounded by the myometrium that stretches almost to the right border of the image.
Normal ultrasound image of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy in
sagittal
Sagittal
Computed Tomography (CT) view:
Note the thin endometrial strip, measuring 0.34 cm, which would be normal in both premenopausal or postmenopausal women.
Ultrasound image of a normal ovary:
Edges of the ovary are noted by white caliper markings. This ovary measures 3.67 x 2.22 cm, which is normal in a premenopausal woman.
Although pelvic MRI is rarely a 1st-line test, it is typically ordered for better visualization of abnormalities that are identified on ultrasound. Some reasons to order a pelvic MRI include:
Tissue | T1-weighted images T1-Weighted Images Imaging of the Head and Brain | T2-weighted images T2-Weighted Images Imaging of the Head and Brain |
---|---|---|
Fluid | Dark | Bright |
Fat | Bright | Bright |
Inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation | Dark | Bright |
Interpretation should follow a systematic and reproducible pattern:
Ultrasound characteristics | MRI characteristics |
---|---|
|
|
Ultrasound image showing an enlarged multicystic ovary in a woman with ovarian hyperstimulation syndrome (OHSS) who was undergoing ovarian stimulation as part of fertility treatments. All cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change seen here are simple cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change.
Image: “Ultrasonographic examination revealed bilaterally enlarged multicystic ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy” by Yildizhan R. et al AL Amyloidosis. License: CC BY 2.0Single
simple cyst
Simple Cyst
Imaging of the Breast:
Note the
hyperechoic
Hyperechoic
A structure that produces a high-amplitude echo (lighter grays and white)
Ultrasound (Sonography) posterior wall enhancement. Measurements in 3 planes are noted in the bottom right corner, indicating that the cyst is approximately 4.7 cm x 3.3 cm x 4.8 cm.
Ultrasound characteristics | MRI characteristics |
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Ultrasound image of a corpus luteum Corpus Luteum The yellow body derived from the ruptured ovarian follicle after ovulation. The process of corpus luteum formation, luteinization, is regulated by luteinizing hormone. Ovaries: Anatomy cyst with thick walls and peripheral color flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure on Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography)
Image by Hetal Verma, MD.Ultrasound characteristics | MRI characteristics |
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|
|
Ultrasound images demonstrating a hemorrhagic cyst:
On the left, note the reticular or lacy pattern of echoes that represent
fibrin
Fibrin
A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot.
Rapidly Progressive Glomerulonephritis strings of a recently formed clot within a hemorrhagic cyst (A). On the right, there is a
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) area where the clot has begun retracting (B).
Ultrasound image of a hemorrhagic ovarian cyst, probably originating from a
corpus luteal cyst
Corpus luteal cyst
Following ovulation, follicles become corpus luteal cysts. Secrete progesterone
Ovarian Cysts:
The hemorrhage is discerned by a grainy
texture
Texture
Dermatologic Examination of higher echogenicity than the fluid in the periphery of the cyst that resembles dark crescents.
A 60-year-old woman with a histologically proven hemorrhagic ovarian cyst:
(a)
Axial
Axial
Computed Tomography (CT) T1-weighted image reveals a nonhomogeneous
cystic
Cystic
Fibrocystic Change
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast with mostly isointense signals in the right adnexal region.
(b) On the
sagittal
Sagittal
Computed Tomography (CT) T2-weighted image, the
cystic
Cystic
Fibrocystic Change component of the
tumor
Tumor
Inflammation is homogenously
hyperintense
Hyperintense
Magnetic Resonance Imaging (MRI), whereas the debris of hemorrhagic components are mostly isointense, morphologically mimicking vegetations on the wall.
(c) On fat-suppressed
T2-weighted images
T2-Weighted Images
Imaging of the Head and Brain, the signal of the
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast is similar to that seen in (b), suggesting that the tissue is fluid and not fat.
(d) The lesion shows weak, marginal enhancement on the contrast-enhanced, fat-suppressed T1-weighted image.
An endometrioma Endometrioma Endometriosis is a collection of endometrial tissue Endometrial tissue The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Endometriosis on the ovary.
Ultrasound characteristics | MRI characteristics |
---|---|
|
|
Hemorrhagic cyst | Endometrioma Endometrioma Endometriosis | |
---|---|---|
T1 | Bright | Bright |
T2 | Bright | Dark |
Resolution | Within 1–2 menstrual cycles → disappears on follow-up scan | Does not resolve spontaneously → persists on follow-up scan |
Sonographic appearances of a typical
endometrioma
Endometrioma
Endometriosis:
Unilocular
cysts
Cysts
Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.
Fibrocystic Change with “ground glass” contents (A) that are poorly vascular or
avascular
Avascular
Corneal Abrasions, Erosion, and Ulcers on color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) examination (B)
Sagittal Sagittal Computed Tomography (CT) (a) T2-weighted image and (b) T1-weighted sagittal Sagittal Computed Tomography (CT) image with fat suppression Suppression Defense Mechanisms showing a typical large endometrioma Endometrioma Endometriosis of the left ovary (large arrow) with satellite hemorrhagic focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast in the anterior wall of this lesion (small arrow)
Image: “ Sagittal Sagittal Computed Tomography (CT) (a) T2-weighted fast SE image (repetition time msec/echo time msec = 2940/66) and T1-weighted sagittal Sagittal Computed Tomography (CT) fast SE image (b)” by Bianek-Bodzak A. et al AL Amyloidosis. License: CC BY 3.0Ultrasound characteristics | MRI characteristics |
---|---|
|
|
Ultrasound image showing a heterogeneous ovarian mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast representing a dermoid cyst
Image by Lecturio.Pelvic MRI showing a dermoid cyst of the left ovary
Image: “Pelvic MRI confirming dermoid cyst of the left ovary” by The Pan African Medical Journal. License: CC BY 2.0Pelvic CT showing a dermoid cyst of the right ovary measuring 36 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma x 37 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma
Image: “Pelvic CT showing dermoid cyst” by The Pan African Medical Journal. License: CC BY 2.0Ovarian neoplasms Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Bone Tumors: benign Benign Fibroadenoma (noninvasive) or malignant (invasive) growths arising from a single cell. Ovarian neoplasms Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Bone Tumors are classified according to their cell of origin as either epithelial, germ cell, or stromal tumors (with many different subtypes in each class). Concerning imaging findings include:
Advanced primary ovarian cancers:
(A) Multilocular ovarian serous adenocarcinoma with increased vascularity
(B) Peritoneal deposits in the rectouterine pouch visible due to significant
ascites
Ascites
Ascites is the pathologic accumulation of fluid within the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection).
Ascites from late-stage primary
ovarian cancer
Ovarian cancer
Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs).
Ovarian Cancer
Mucinous cystadenoma with
variable
Variable
Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups.
Types of Variables echogenicity among the cyst locules:
Note the multiple septations and solid components. A mucinous cystadenoma is a
benign
Benign
Fibroadenoma epithelial ovarian
tumor
Tumor
Inflammation that can become quite large.
Enhanced T2-weighted MRI showing an irregular right adnexal
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast and
ascites
Ascites
Ascites is the pathologic accumulation of fluid within the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection).
Ascites
A:
sagittal
Sagittal
Computed Tomography (CT) view
B:
axial
Axial
Computed Tomography (CT) view
Ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion refers to the acute twisting of the ovary around its blood supply. Ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion presents with acute pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways and is considered a surgical emergency Surgical Emergency Acute Abdomen (to untwist/save the ovary). Evaluation is usually only with ultrasound.
An ectopic pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care is a pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care outside the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy. A rupture can result in life-threatening hemorrhage. An ectopic pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care is almost always evaluated using ultrasound only.
Transvaginal ultrasound
Transvaginal Ultrasound
Obstetric Imaging of right adnexa showing right tubal ectopic
pregnancy
Pregnancy
The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.
Pregnancy: Diagnosis, Physiology, and Care with a gestational sac and fetus consistent with 6 weeks of gestation visible:
Note the measurement in the bottom left corner:
crown-rump length
Crown-Rump Length
Obstetric Imaging (CRL) = 0.43 cm 6w0d
A rare
heterotopic
Heterotopic
Transplantation of tissue typical of one area to a different recipient site. The tissue may be autologous, heterologous, or homologous.
Organ Transplantation
pregnancy
Pregnancy
The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.
Pregnancy: Diagnosis, Physiology, and Care:
A twin gestation where 1
pregnancy
Pregnancy
The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.
Pregnancy: Diagnosis, Physiology, and Care is in the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy (UT) and the other is ectopic. In this image, the ectopic
pregnancy
Pregnancy
The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.
Pregnancy: Diagnosis, Physiology, and Care is noted to the left, surrounded by
blood flow
Blood flow
Blood flow refers to the movement of a certain volume of blood through the vasculature over a given unit of time (e.g., mL per minute).
Vascular Resistance, Flow, and Mean Arterial Pressure visible on
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography), with a significant amount of free fluid (
FF
FF
Fraction of the RPF that actually moves across the glomerular membrane
Glomerular Filtration) in the
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy.
A hydrosalpinx describes the condition of postinflammatory fluid filling the fallopian tube Fallopian Tube A pair of highly specialized canals extending from the uterus to its corresponding ovary. They provide the means for ovum transport from the ovaries and they are the site of the ovum’s final maturation and fertilization. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells. Uterus, Cervix, and Fallopian Tubes: Anatomy.
Uterine fibroids Fibroids A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissue, probably arising from the smooth muscle of small blood vessels in these tissues. Infertility (or leiomyomas) are benign Benign Fibroadenoma uterine neoplasms Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Bone Tumors arising from a single myometrial cell:
Ultrasound characteristics | MRI characteristics |
---|---|
|
|
A 46-year-old woman with a history of
abdominal pain
Abdominal Pain
Acute Abdomen:
Transvaginal ultrasound
Transvaginal Ultrasound
Obstetric Imaging (TVUS) image shows a 1.1-cm submucosal fibroid (arrow) with posterior acoustic shadowing (arrowheads).
A 49-year-old woman with a history of menorrhagia:
Transabdominal ultrasound (TAUS) image (A) shows a bulky
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy with a 10-cm submucosal fibroid, appearing to “fill” the endometrial cavity.
Sagittal
Sagittal
Computed Tomography (CT) T2-weighted MRI image (B) in the same subject shows that the submucosal fibroid (arrowhead) is heterogeneous, indicating degeneration. There is also a 2.5-cm cervical fibroid (arrow).
A 51-year-old woman with a history of menorrhagia:
Sagittal
Sagittal
Computed Tomography (CT) T2-weighted MRI shows a bulky
retroverted uterus
Retroverted Uterus
Female Genitourinary Examination containing multiple intramural
fibroids
Fibroids
A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissue, probably arising from the smooth muscle of small blood vessels in these tissues.
Infertility and a large submucosal fibroid (arrow) projecting into the endometrial cavity. A complex ovarian cyst is also incidentally demonstrated posterior to the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy (arrowhead). The full
bladder
Bladder
A musculomembranous sac along the urinary tract. Urine flows from the kidneys into the bladder via the ureters, and is held there until urination.
Pyelonephritis and Perinephric Abscess can be appreciated as the
hyperintense
Hyperintense
Magnetic Resonance Imaging (MRI) region on the left side of the image.
A 43-year-old woman with menorrhagia:
Sagittal
Sagittal
Computed Tomography (CT) T2-weighted MRI image shows multiple intramural
fibroids
Fibroids
A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissue, probably arising from the smooth muscle of small blood vessels in these tissues.
Infertility (arrows). The largest (arrowhead) lying anteriorly measures 8.5 cm. Images show typical low-signal intensity.
Adenomyosis Adenomyosis Adenomyosis is a benign uterine condition characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Adenomyosis is a common condition, affecting 20%-35% of women, and typically presents with heavy menstrual bleeding and dysmenorrhea. Adenomyosis is a clinical condition in which the endometrium Endometrium The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Embryoblast and Trophoblast Development implants/invades into the myometrium, typically resulting in heavy, painful menstruation Menstruation The periodic shedding of the endometrium and associated menstrual bleeding in the menstrual cycle of humans and primates. Menstruation is due to the decline in circulating progesterone, and occurs at the late luteal phase when luteolysis of the corpus luteum takes place. Menstrual Cycle. Findings on both ultrasound and MRI include:
Ultrasonographic diagnostic criteria for
adenomyosis
Adenomyosis
Adenomyosis is a benign uterine condition characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Adenomyosis is a common condition, affecting 20%-35% of women, and typically presents with heavy menstrual bleeding and dysmenorrhea.
Adenomyosis:
a) Globular
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy
b) Uterine
asymmetry
Asymmetry
Examination of the Upper Limbs: longitudinal section of a
retroverted uterus
Retroverted Uterus
Female Genitourinary Examination, where the posterior uterine wall is clearly thicker than the anterior wall
c) Heterogeneous myometrial
texture
Texture
Dermatologic Examination: transverse section of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy at the
fundus
Fundus
The superior portion of the body of the stomach above the level of the cardiac notch.
Stomach: Anatomy level, where
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) areas with radial pattern can be seen (arrows)
d) Linear striations: In this
sagittal
Sagittal
Computed Tomography (CT) section of an
anteverted uterus
Anteverted Uterus
Female Genitourinary Examination, thin hyperechogenic lines cross the myometrial thickness and are visible from the endometrial-myometrial interface.
e) Intramyometrial
cysts
Cysts
Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.
Fibrocystic Change: transverse section of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy at the level of the
fundus
Fundus
The superior portion of the body of the stomach above the level of the cardiac notch.
Stomach: Anatomy with sonolucent areas distributed in the posterior wall of the myometrium
f) Hyperechogenic nodules: transverse section of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy at the level of the
fundus
Fundus
The superior portion of the body of the stomach above the level of the cardiac notch.
Stomach: Anatomy showing hyperechogenic areas in the myometrium
Diffuse
adenomyosis
Adenomyosis
Adenomyosis is a benign uterine condition characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Adenomyosis is a common condition, affecting 20%-35% of women, and typically presents with heavy menstrual bleeding and dysmenorrhea.
Adenomyosis:
Sagittal
Sagittal
Computed Tomography (CT) T2-weighted image; thickening of the junctional zone forming an ill-defined area of low signal intensity, with punctate high-intensity myometrial foci representing areas of
endometrium
Endometrium
The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo.
Embryoblast and Trophoblast Development embedded within the myometrium
A small growth off the endometrium Endometrium The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Embryoblast and Trophoblast Development that is usually pedunculated and often (though not always) benign Benign Fibroadenoma:
A pedunculated endometrial polyp seen on a saline infusion sonogram Sonogram Chorioretinitis ( SIS SIS Infertility)
Image: “3D-MS- View of endometrial outline in the transverse plane Transverse plane Anterior Abdominal Wall: Anatomy shows a localized lesion” by Zafarani F., Ahmadi F. License: CC BY 2.5, cropped by Lecturio.Endometrial thickening consistent with endometrial hyperplasia Endometrial Hyperplasia Benign proliferation of the endometrium in the uterus. Endometrial hyperplasia is classified by its cytology and glandular tissue. There are simple, complex (adenomatous without atypia), and atypical hyperplasia representing also the ascending risk of becoming malignant. Endometrial Hyperplasia and Endometrial Cancer
Image: “Glandular cystic Cystic Fibrocystic Change hyperplasia Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. Cellular Adaptation that is softer than the myometrium on SEG.E endometrium Endometrium The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Embryoblast and Trophoblast Development” by Goncharenko V. M. et al AL Amyloidosis. License: CC BY 2.0, edited by Lecturio.Systematic approach:
Normal
hysterosalpingography
Hysterosalpingography
Radiography of the uterus and fallopian tubes after the injection of a contrast medium.
Congenital Malformations of the Female Reproductive System findings:
Radiograph showing normal uterine contour with bilateral fill and spill of dye from the
fallopian tubes
Fallopian tubes
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle.
Uterus, Cervix, and Fallopian Tubes: Anatomy
Hydrosalpinx:
Hysterosalpingogram Hysterosalpingogram Infertility showing bilateral tubal occlusion and hydrosalpinges Hydrosalpinges Infertility
Image: “HSG showing bilateral tubal blockage” by Aziz M.U. et al AL Amyloidosis. License: CC BY 3.0CUAs:
The uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy forms from the Müllerian ducts, which fuse in the midline to create the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy, cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy, and upper vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy. Therefore, initially, these structures are divided down the midline before the midline septum regresses. Congenital Congenital Chorioretinitis uterine abnormalities typically occur due to abnormal fusion and/or septal regression Regression Corneal Abrasions, Erosion, and Ulcers.
Malformations of the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy
Image by Lecturio. License: CC BY-NC-SA 4.0
Hysterosalpingogram
Hysterosalpingogram
Infertility of an infertile subject showing a
bicornuate uterus
Bicornuate Uterus
Congenital Malformations of the Female Reproductive System:
The right
fallopian tube
Fallopian Tube
A pair of highly specialized canals extending from the uterus to its corresponding ovary. They provide the means for ovum transport from the ovaries and they are the site of the ovum’s final maturation and fertilization. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells.
Uterus, Cervix, and Fallopian Tubes: Anatomy has either not yet filled with the dye or is obstructed. The left
fallopian tube
Fallopian Tube
A pair of highly specialized canals extending from the uterus to its corresponding ovary. They provide the means for ovum transport from the ovaries and they are the site of the ovum’s final maturation and fertilization. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells.
Uterus, Cervix, and Fallopian Tubes: Anatomy appears to be starting to fill.
Hysterosalpingogram Hysterosalpingogram Infertility showing a unicornuate uterus Unicornuate Uterus Congenital Malformations of the Female Reproductive System
Image: “ Unicornuate uterus Unicornuate Uterus Congenital Malformations of the Female Reproductive System” by Aziz M.U. et al AL Amyloidosis. License: CC BY 3.0Comparison of three-dimensional ultrasound and
hysterosalpingography
Hysterosalpingography
Radiography of the uterus and fallopian tubes after the injection of a contrast medium.
Congenital Malformations of the Female Reproductive System in cases of uterine malformation:
A: normal
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy
B:
unicornuate uterus
Unicornuate Uterus
Congenital Malformations of the Female Reproductive System
C:
arcuate uterus
Arcuate Uterus
Congenital Malformations of the Female Reproductive System
D-G: subtypes of the
septate uterus
Septate Uterus
Congenital Malformations of the Female Reproductive System (partial-to-complete septum)
H:
bicornuate uterus
Bicornuate Uterus
Congenital Malformations of the Female Reproductive System
I:
didelphys
Didelphys
Congenital Malformations of the Female Reproductive System