GYN IMAGING

1. Describe findings of early pregnancy

2. Describe findings of early pregnancy complications

3. Explain appearance of ovarian cysts

Functional cysts = follicular & CL
Well defined, thin walled, anechoic
Homogenous internal fluid density
Echogenic if hemorrhage
Nonfunctional cysts = dermoid, endometriomas, polycystic
ovaries
Follicular cysts
Follicle fills w/ fluid and doesn't rupture
Unilateral, asymptomatic
Involute during next menstrual cycle
Corpus luteal cyst
CL forms after expulsion of egg
Fills w/ fluid
Less common than follicular cysts
More painful, larger
Most involute in 6-8 weeks
Dermoid cysts
Mature teratomas
From 3 germ layers (ectoderm, mesoderm,
endoderm)
Mostly ectoderm hair & bone
Reproductive age
25% bilateral
Endometriomas
In endometriosis
Chocolate cysts filled with brown/red blood
Large, multilocular
Polycystic ovarian disease (PCOS)
Endocrine problem
12+ follicles per ovary
At various stages
Stein-Leventhal syndrome: oligomenorrhea, hirsutism,
obesity

4. Explain appearance of uterine masses

Epidemiology
Cysts are MC mass
Leiomyomas on myometrium are MC tumors
Endometrial carcinomas usually confined to uterus
 Anatomy
Anterior & posterior (rectouterine) cul de sac
Anteverted & anteflexed
Pear shaped 8x 5x 4 cm
Smaller with aging
Endometrial cavity: thin, echogenic stripe or line between
surfaces of endometrium
Double thick on sagittal view
Varies w/ menstrual cycle
Ultrasound Types
US is imaging of choice for pelvic mass or pain
Transabdominal US done w/ full bladder
Acoustic window to uterus (blocks bowel loops out of
pelvis)
Transvaginal done w/ empty bladder
Higher frequency probe, better resolution
Sonohysterography: saline put into uterine cavity
Done w/ transvaginal US
Detects small uterine polyps, submucosal myomas,
adhesions
Uterine Leiomyomas (Fibroids)
Benign smooth muscle tumors
Asymptomatic pain, infertility, menorrhagia, urinary
probs
US
Imaging of choice
Heterogeneously hypoechoic, solid masses
Absorb sound for acoustical shadowing
Calcium makes shadowing too
Anechoic where necrotic
MRI
For surgical planning
CT
Lobulated soft tissue masses
Calcify w/ amorphous or popcorn calcification
Central necrosis low attenuation
Myometrium (vascular) enhances w/ contrast

5. Explain appearance of ovarian masses

Normal ovaries
US study of choice
2 x 3 x 4 cm
Cystic follicles are normal (2.5 cm @ ovulation)
Atrophy after menopause
 Ovarian tumors
Most from surface epithelium
Most benign
Serous tumors MC
Serous cystadenomas, adenocarcinomas
Mucinous tumors
Mucinous cystadenomas, adenocarcinomas
US: cystic looking, thick & irregular walls, internal
septations
Ovarian cancer spreads through peritoneal cavity
Omental cake: mets in omentum & peritoneal
surface
Makes elongated nodular mass
Youll have ascites too
Pelvic Inflammatory Disease (PID)
Infectious diseases affecting uterus, fallopian tubes,
ovaries
Begins as transient endometritis tubes/ovaries
Pain, discharge, adnexal tenderness, high WBC
Infertility, chronic pain, ectopic
US
Enlarged ovaries
Multiple cysts, periovarian inflammation
Pyosalpinx: fluid filled, dilated fallopian tube
Tubo-ovarian complex: fusion of dilated fallopian tube
& ovary
Tubo-ovarian abscess: multiloculated mass w/
septations
CT
For complicated PID
Need IV contrast
Haziness of pelvic fat
Thickened tubes- may be folded upon themselves,
fluid filled, multicystic
Enlarged uterus w/ enhancement
Pyosalpinx & tubo-ovarian abscess w/ focal
hypodensity
Pelvic ascites
Ascites
Abnormal accumulation of fluid in peritoneal cavity
Recumbent position: in right paracolic gutter right
subphrenic space
US
RUQ between liver & diaphragm
 Transudate sonolucent
Exudate/Hemorrhage echoes
Guides paracentesis

6. Describe findings in dysfunctional uterine bleeding

7. Describe findings and work up of benign and malignant breast lesions

Mammogram
Fat is lucent (dark)
Cancer is dense (white)
Craniocaudal & axillary oblique views
AO good view for axillary tail
Microcalcifications: under 1 cm, can be sign of cancer
Biopsies can leave scars that look like neoplasms
Compare w/ old images
Not palpable do stereotactic needle biopsy or
needle localization
Leaking implants cant be seen on mammo (unless
deflated)
Can see calcification near implant on XR

Tomosynthesis
3D mammo
Good for dense breasts
US
Solid vs. cystic
Needle biopsy guidance
Nuclear med
Localize sentinel lymph node
MRI
High risk patients
20-25%+ per US Cancer Institute, BRCA, chest radiation
under 30, hx. of cancer
CT
NOPE!

8. Describe findings and work up of benign and malignant testicular

lesions
General info
Epididymitis, torsion, hydrocele MC
 Masses in testicle usually malignant
95% germ cell tumors seminoma, embryonal
carcinoma, choriocarcinoma, teratoma
Masses in scrotum usually benign
Doppler US
1st choice for testicle <3
Epididymitis: hyperemia on affected side
Acute torsion: decreased blood flow on side w/ pain
Missed torsion: hypervascular rim
Hydroceles & varicoceles easily dx.

9. Explain imaging work up of infertility

10. Explain use of imaging in the staging of gynecological
malignancy