What should you always evaluate in patients with congenital malformations?
The Urinary Tract
What is the most common tumor of the female pelvis?
Lieomyoma clinical signs include: I A IF HE
I - Infertility
A - alteration in NML menstrual flow
I - increasing pain with degenerative changes. F - frequent urination
H - heavy periods (menometorrhagia) E - enlarged UT
Lieomyoma - sono - SWWELPD
S - shadowing W - well circumscribed W - whirled interior architexture E - extrinsic compression of post bladder wall L - lobulated UT contour P - pedunculated may appear as hypo adnexal mass. D - displacement of endo echoes
Benign invasion of endometrial glands and stoma into the myometrium.
Adenomyosis occurs in ------- year old women with ------ and ------.
40-50 dysmenorrhea irregular bleeding
Adenomyosis can produce myometrial cysts measuring what?
"venetian blind" type shadowing is associated with what?
What is the most common encountered gynecologic malignancy?
Endometrial Carcinoma has a relationship with what?
Endometrial Carcinoma - risk factors - OHH PS
O - obesity H - history of atypical hyperplasia of endo H - history of tamoxifen
P - postmeno, wtih increased risk if on ERT S - strong family history of UT cancer
Endometrial Carcinoma - sono - II FAT
I - increased UT size I - inhomogenicity
F - fluid in EC A - alteration in size, shape, & sono texture of UT. T - thickened endo (4-5 mm) esp in postmeno women
Proliferation of endometrial glandular tissue.
What may Endometrial Hyperplasia be caused by?
Unopposed Estrogen Hormone Replacement Therapy
Endometrial Hyperplasia is a common cause of what?
Endometrial Hyperplasia may be caused by: U POPE
U - unopposed EHRT
P - PCOD O - obesity P - persistent anovulatory cycles E - estrogen producing tumors of the OV
Estrogen producing tumors of the ovaries include which 2 types?
Granulosa cell tumors Thecomas
What is the endo measurement for Endometrial Hyperplasia in premeno women?
What is the endo measurement for Endometrial Hyperplasia in postmeno women on estrogen only?
What is the endo measurement for Endometrial Hyperplasia in postmen in estrogen phase?
up to 8 mm, decreases in progest. phase
Localized overgrowths of endo tissue.
What does SIS stand for?
Saline Infusion Sonohysterography
What is SIS also called?
Follicular cysts usually measure:
What is the maximum measurement of a normal dominant follicle?
Corpus luteal cysts rarely exceed what size?
Corpus luteal cysts can be seen with pregnancy but usually resolve by how many weeks?
What are the largest of the functional cysts?
Theca lutein cysts
Polycystic Ovarian Syndrome is also called:
Multiple bilateral cysts are seen with PCOS, measuring:
During or after implantation of a fertilized ovum. (can occur months to years after preg)
What do paternal genomes control?
Proliferation of trophoblastic tissue.
What do maternal genomes control?
Growth of the embryo
What causes GTD?
Duplication of chromosomes in the sperm Lack of chromosomes in the ovum Fertilization of the ovum by 2 sperm
GTD - clinical - HHVE MATE
H - hyperthyroidism H - hyperemesis gravidarum V - vaginal bleeding/tissue E - enlarged UT
M - markedly elevated hCG levels A - absence of fetal heart tones T - theca lutein cysts E - early onset of pre-eclampsia
GTD - Complete Hydatidaform Mole
The chorionic villi are hydropic without identifiable embryonic or fetal tissue.
GTD - what is the most common form of trophoblastic disease?
Complete Hydatidaform Mole
GTD - Complete Hydatidaform Mole - sono - HEET
H - hypervascular, low resistance flow E - enlarged UT filled with echogenic mass E - EC filled with echogenic material (homogeneous in the 1st trimester, cystic areas in the 2nd trimester) T - theca lutein cysts
GTD - Partial Mole
Has 1 set of maternal chromosomes and 2 sets of paternal chromosomes. (Results in triploid karyotype)
GTD - Partial Mole have ---- and ----- villi.
hydropic chorionic villi relatively normal villi
GTD - Partial Mole - Is fetal tissue frequently identified?
GTD - Partial Mole - sono
Deformed GS Growth Restricted Fetus Triploidy anomalies (syndactyly & hydrocephalus) Enlarged PL with multiple cystic areas
GTD - Mole with Coexisting Normal Fetus
Two conceptions: 1 develops normally 1 develops into GTD
GTD - Mole with Coexisting Normal Fetus - sono
Similar to Partial mole Normal PL and membranes can be identified Fetus usually has normal karyotype
PTN stands for what?
Persistent Trophoblastic Neoplasm
Persistent Trophoblastic Neoplasm
Complication of pregnancy that most commonly follows GTD.
When can PTN occur after, besides GTD?
Normal term delivery SAB Ectopic pregnancy
What are at high risk for PTN?
Severe degrees of trophoblastic proliferation
What is at low risk for PTN?
What are the 2 types of PTN?
1. Invasive Mole 2. Choriocarcinoma
Invasive Mole is also called what?
What is the most common form of PTN?
Penetrates the myometrium or adjacent structures. May cause uterine rupture Malignant, Non-metastatic GTD
Invasive Mole - sono - FIM
F - focal/diffuse echogenic material in EC I - irregular, sonolucent areas surrounding trophoblastic tissue. M - may see extending into the myometrium
What commonly occurs with Choriocarcinoma?
Vascular invasion Hemorrhage Necrosis of the myometrium
Choriocarcinoma may metastasize to which structures?
Lung Liver Brain Bone GI tract Skin
Choriocarcinoma - sono
Elevated hCG in non-pregnant patient Enlarge UT Irregular complex mass w/ marked vascularity
Maternal blood pressure is considered elevated when it measures what?
When is organogenesis completed by?
In which plane is the diagphragm best seen?
Where should the thoracic circumference be measured?
True transverse view at the level of the four chamber heart.
Is the umbilical cord high resistance or low resistance flow?
Is the middle cerebral artery high resistance or low resistance flow?
What condition is most common among pediatric patients?
What should not be used to clean a vaginal transducer?
Which is more accurate: the BPD or HC measurement?
What is the double bleb sign?
The sonographic presentation of the amnion and yolk sac.
Is the left lobe or right lobe of the liver larger in a fetus?
Protrusion of the intestines into the amniotic cavity. Affects all 3 layers of the abdominal wall.
Where does Gastroschisis occur?
Lateral to the umbilical cord insertion. (Usually to the right)
Gastroschisis - Are the intestines covered with a membranous sac?
What does a Omphalocele result from?
Failure of the intestines to return to the abdomen during the second stage of intestinal rotation.
Omphalocele - Are the intestinal contents covered by a membranous sac?
Omphalocele - What is the membranous sac made of?
where is a Omphalocele seen?
At the level of the umbilical cord insertion.
Omphalocele - What can rupture of the sac during delivery cause?
Are there other anomalies associated with Gastroschisis?
What are some of the anomalies associated with Omphalocele?
Cardiac defects Trisomy 13 Trisomy 18
What can be seen in a Omphalocele?
Liver Bowel loops Mesentery Omentum Sometimes pancreas and spleen
What kind of Omphaloceles have a greater risk of associated chromosome abnormalities?
Omphalocele's containing bowel only.
Exposure and protrusion of the urinary bladder.
Bladder Exstrophy - What does this midline defect usually involve?
Lower Abdominal Wall Anterior wall of the BL
What can Bladder Exstrophy be associated with?
Genital Anomalies (cleft clitoris, epispadias, with separation of pelvic bones)
What is ascites in the fetal abdomen most commonly associated with?
Persistant Right Umbilical Vein
When the umbilical vein courses toward the left side of the fetal abdomen.
Persistant Right Umbilical Vein - The umbilical vein actually enters the ----------- of the liver rather than the -----------.
Right portal vein Left portal vein
Persistant Right Umbilical Vein- is there always something pathological with this?