Untitled > Chapter 43 > Flashcards

Chapter 43 Flashcards

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1
Q

What is the shape and location of the ovaries?

A

Paired, almond-shaped structures situated one on each side of uterus close to lateral pelvic wall

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2
Q

How can the position of the ovaries vary?

A

Influenced by uterine location and ligament attachments

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3
Q

In an anteflexed midline uterus, where are the ovaries usually identified?

A

Laterally or posterolaterally

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4
Q

What happens to the position of the ovaries when the uterus lies to one side of midline?

A

Ipsilateral ovary often lies superior to uterine fundus

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5
Q

In a retroverted uterus, where do the ovaries tend to be located?

A

Lateral and superior, near uterine fundus

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6
Q

What occurs to the ovaries when the uterus is enlarged?

A

Ovaries tend to be displaced more superiorly and laterally

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7
Q

After a hysterectomy, where are the ovaries typically located?

A

More medially and directly superior to vaginal cuff

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8
Q

What is the normal sonographic appearance of the ovaries?

A

Homogeneous echotexture with possible central echogenic medulla and small anechoic or cystic follicles in cortex

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9
Q

What cyclic changes are recognized sonographically during each menstrual cycle?

A

Three phases during reproductive years

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10
Q

What hormone stimulates follicle development in the early proliferative phase?

A

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

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11
Q

What indicates a mature follicle and imminent ovulation?

A

Visualization of cumulus oophorus as a cystlike protrusion

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12
Q

What develops if fluid in nondominant follicles is not reabsorbed?

A

Follicular cyst

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13
Q

What happens to the dominant follicle after ovulation?

A

Usually disappears immediately after rupture

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14
Q

What is seen in the cul-de-sac after ovulation?

A

Fluid commonly seen, peaking in early luteal phase

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15
Q

What structure develops in the luteal phase and may be identified sonographically?

A

Mature corpus luteum

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16
Q

What is the appearance of a mature corpus luteum on ultrasound?

A

Small hypoechoic or isoechoic structure with irregular echogenic crenulated walls

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17
Q

What is the expected behavior of the corpus luteum in the absence of fertilization?

A

Begins to undergo involutional changes and disappears before menstruation

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18
Q

What is the normal volume of an ovary in an adult menstruating female?

A

May have volume as large as 22 cc, with mean ovarian volume of 9.8 ± 5.8 cc

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19
Q

What volume is considered abnormal for a postmenopausal patient?

A

More than 8.0 cc

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20
Q

What is the prolate ellipse formula used for?

A

Determining overall ovarian size through volume measurement

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21
Q

What are the sonographic criteria for a simple cyst?

A

Thin smooth wall, anechoic contents, and acoustic enhancement

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22
Q

What is typically recommended for postmenopausal cysts greater than 5 cm?

23
Q

What are common types of cystic or complex ovarian masses?

Study These Flashcards
A
  • Follicular cyst
  • Corpus luteum cyst of pregnancy
  • Cystic teratoma
  • Paraovarian cyst
  • Hydrosalpinx
  • Endometrioma
  • Hemorrhagic cyst
24
Q

What can a simple cyst that hemorrhages appear as?

25
What are classic differential considerations of a complex adnexal mass?
* Ectopic pregnancy * Endometriosis * Pelvic inflammatory disease (PID)
26
What increases the likelihood of a tumor being malignant?
More sonographically complex the tumor, especially if associated with ascites
27
What are common solid masses found in ovarian tumors?
* Solid teratoma * Adenocarcinoma * Arrhenoblastoma * Fibroma * Dysgerminoma
28
What is the role of color Doppler in ovarian ultrasound?
Helpful in differentiating potential cyst from adjacent vascular structures
29
What is the cut-off value for Pulsatility Index (PI) indicating malignancy?
1.0
30
What does a high diastolic flow suggest in terms of ovarian pathology?
Neovascularity and likelihood of malignancy
31
What are functional cysts?
Cysts that result from normal function of ovary, including follicular, corpus luteum, hemorrhagic, and theca-lutein cysts
32
What is a common characteristic of follicular cysts?
Thin-walled, translucent, with watery fluid
33
What are the clinical findings associated with corpus luteum cysts?
* Irregular menstrual cycle * Pain * Mimic ectopic pregnancy * Rupture
34
What happens in acute hemorrhagic cysts?
Usually hyperechoic and may mimic solid mass
35
What are theca-lutein cysts associated with?
High levels of human chorionic gonadotropin
36
What type of cysts are the largest of the functional cysts?
Theca-lutein cysts
37
What are the characteristics of Theca-lutein cysts?
Large, bilateral, multiloculated cystic masses associated with high levels of human chorionic gonadotropin (hCG) ## Footnote Seen in 30% of patients with trophoblastic disease
38
What is the clinical presentation of Ovarian Hyperstimulation Syndrome (OHS) in its mild form?
Pelvic discomfort but no significant weight gain, with ovaries enlarged measuring less than 5 cm in diameter ## Footnote OHS is a frequent iatrogenic complication of ovulation induction
39
What are the severe symptoms of Ovarian Hyperstimulation Syndrome?
Severe pelvic pain, abdominal distention, and enlarged ovaries measuring greater than 10 cm in diameter ## Footnote Associated with ascites, pleural effusions, and numerous large, thin-walled cysts throughout the periphery of the ovary
40
What defines Polycystic Ovarian Syndrome?
Includes Stein-Leventhal syndrome, bilaterally enlarged polycystic ovaries, and occurs in late teens through 20s ## Footnote May have endocrine imbalance
41
What are the common clinical findings of Polycystic Ovarian Syndrome?
Amenorrhea, obesity, infertility, hirsutism ## Footnote Spectrum of sonographic appearances
42
What are Peritoneal Inclusion Cysts?
Cysts lined with mesothelial cells formed when adhesions trap peritoneal fluid around ovaries ## Footnote Result in large adnexal mass and often present with pelvic pain
43
What are the characteristics of Paraovarian Cysts?
Usually simple, can bleed or torse, and are Wolffian duct remnants located in the broad ligament ## Footnote Ten percent of all adnexal masses
44
What is Endometriosis?
A common condition where functioning endometrial tissue is present outside the uterus ## Footnote Ectopic tissue can be found in various pelvic locations
45
What are the two forms of Endometriosis?
* Diffuse form * Localized form (endometrioma) ## Footnote Diffuse form is more common and consists of endometrial plantings within peritoneum
46
What are the sonographic findings for Endometriosis?
May appear as bilateral or unilateral ovarian cysts, with patterns ranging from anechoic to solid ## Footnote Depends on the amount of blood and its organization
47
What is an Endometrioma?
Well-defined unilocular or multilocular predominantly cystic mass containing diffuse homogeneous, low-level internal echoes ## Footnote Also known as a chocolate cyst
48
What causes Ovarian Torsion?
Partial or complete rotation of the ovarian pedicle on its axis ## Footnote Produces enlarged edematous ovary, usually greater than 4 cm in diameter
49
What are the classical sonographic findings of Ovarian Torsion?
Multiple tiny follicles around a hypoechoic mass to a completely solid adnexal mass, often with free fluid present ## Footnote Doppler examination usually reveals absent blood flow to the torsed ovary
50
What is the clinical presentation of Ovarian Torsion?
Acute severe unilateral pain, intermittent pain may precede acute pain, fever, nausea, vomiting, and palpable mass in over 50% of patients ## Footnote Right ovary is three times more likely to torse than the left
51
What can be the complications of Ovarian Torsion?
Causes edema and eventual loss of arterial perfusion with subsequent infarct ## Footnote Torsion typically involves not only the ovary but also the fallopian tube
52
What are the characteristics of a torsed ovary?
Typically enlarged and heterogeneous in appearance, with edema, hemorrhage, or necrosis ## Footnote Torsed masses vary in appearance from cystic to solid and echogenicity from relatively anechoic to markedly hyperechoic
53
What is the incidence of torsion occurring in contralateral adnexa after one torsion event?
10% increased incidence of torsion occurring in contralateral adnexa ## Footnote Torsion of normal ovary usually occurs in children and younger females
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