Imaging of the Uterus

Sonographic Technique

A. Transabdominal Sonogram: 1. Performed with a distended bladder 2. Transducer is 3.5 to 5.0 Mhz 3. Done in sagittal & transverse planes
B. Transvaginal Sonogram: 1. Performed with an empty bladder 2. Transducer is 5.0 to 7.5 Mhz 3. Done in sagittal & coronal planes

ADVANTAGES OF TVS
Higher frequency = better resolution possible without filling bladder in obese patients in evaluating retroverted uterus better distinction of adnexae & bowels greater detail of internal characteristics of pelvic masses

SYSTEMATIC EXAMINATION OF THE PELVIS

1.
2. 3. 4. 5.

Locate the uterus Examine the endometrium Visualize the cervix Image the adnexae Examine the posterior cul-de-sac

SONOGRAPHIC ANATOMY

Lies in the true pelvis between the urinary bladder and rectosigmoid colon Variable uterine position: Flexion Version Size and Shape varies: 1. Infantile or Prepubertal: L = 2.0 - 3.3 cms AP=0.5 - 1.0 cms. Tubular or inverse pear shape

2. Neonatal: L = plus 0.6 - 0.9 of infantile AP = plus 0.7 - 0.8 of infantile

3. Postpubertal/ Adult: maximum dimensions : L= 8 cms W= 5 cms AP= 4 cms

4. Multiparous: increase in size by more than 1 cm in each adult dimension 5. Postmenopausal: uterus atrophies, most rapid after 10 yr Over 65 y/o : L = 3.5 - 6.5 cms. AP= 1.2 - 1.8 cms.

NORMAL MYOMETRIUM

1. Inner layer
2. Intermediate layer 3. Outer layer

NORMAL ENDOMETRIUM

1. Superficial Functional layer 2. Deep Basal Layer

PREMENOPAUSAL ENDOMETRIUM

Menstrual Phase
Proliferative Phase Secretory Phase

thin echogenic line

hypoechoic thickening 4 to 8 mm hyperechoic thickening 7 to 14 mm

MENSTRUAL PHASE

PROLIFERATIVE PHASE

SECRETORY PHASE

CONGENITAL UTERINE MALFORMATIONS

Due

to arrested development of Mullerian ducts Failure of fusion of Mullerian ducts Failure of resorption of median septum

Bicornuate Uterus - Gravid

ABNORMALITIES OF THE MYOMETRIUM

1. 2. 3. 4. 5.

Leiomyoma Lipoleiomyoma Leiomyosarcoma Adenomyosis Arteriovenous Malformations

LEIOMYOMA CLASSIFICATION
1. Intramural : confined to the myometrium 2. Submucosal : projecting into the uterine cavity 3. Subserosal : projecting from the peritoneal surface

LEIOMYOMA CLASSIFICATION

LEIOMYOMA CLASSIFICATION

1. Intramural Myoma

LEIOMYOMA CLASSIFICATION

2. Submucous Myoma

LEIOMYOMA CLASSIFICATION

3. Subserous Myoma

LIPOLEIOMYOMA

LEIOMYOSARCOMA

ADENOMYOSIS

CAUSES OF ENDOMETRIAL THICKENING

Early intrauterine pregnancy Incomplete abortion Ectopic pregnancy Retained products

Trophoblastic disease Endometritis Adhesions Hyperplasia Polyps Carcinoma

ABNORMALITIES OF THE ENDOMETRIUM

1. 2. 3. 4. 5. 6. 7. 8. 9.

Postmenopausal endometrium Hydrometrocolpos & Hematometrocolpos Endometrial hyperplasia Endometrial hypertrophy Endometrial polyps Endometrial carcinoma Endometritis Endometrial Adhesions (Synechiae) Intrauterine Devices

ABNORMALITIES OF THE ENDOMETRIUM

RECOMMENDATIONS FOR POSTMENOPAUSAL WOMEN (Endometrial Thickness)
=/< 4 mm 5-8 mm >8 mm

Bleeding

No Bleeding

Bleeding

No Bleeding

Sequencial Hormones

All Other Hormone Regimens

No Biopsy (probably atrophy)

Normal

Biopsy

Probably Rescan Early normal or late in no biopsy cycle

Biopsy

if still >8 mm, then biopsy

ABNORMALITIES OF THE ENDOMETRIUM

Hematometrocolpos

ABNORMALITIES OF THE ENDOMETRIUM

Endometrial Hyperplasia

ABNORMALITIES OF THE ENDOMETRIUM

Endometrial Polyps

ABNORMALITIES OF THE ENDOMETRIUM

Endometrial Carcinoma

ABNORMALITIES OF THE ENDOMETRIUM

Endometritis

ABNORMALITIES OF THE ENDOMETRIUM

Intrauterine Device

ABNORMALITIES OF THE CERVIX

1. 2. 3. 4.

Nabothian cysts Cervical polyps Cervical Stenosis Cervical carcinoma

ABNORMALITIES OF THE CERVIX

Nabothian cysts

ABNORMALITIES OF THE CERVIX

Cervical Polyp

Thank you!!!