Pelvis imaging

Question 1

Sonohysterography

Answer 1

Question 2

Nabothian cyst

Answer 2

• Common finding in the uterus on pelvic ultrasound
• Discrete cystic structures that form when a cleft of columnar epithelium becomes covered with squamous cells and the columnar cells continue to secrete mucoid material. The cysts vary from microscopic to several centimeters in size
• Typically asymptomatic, can be ablated using electrosurgery if symptoms are present.

Question 3

The rule of 1-2-3

Answer 3

• The 1-2-3 rule is a simple aide-mémoire describing the nomenclature of any small simple anechoic structure in the ovary on ultrasound:
  
  • <1 cm = follicle.
  • 1-2 cm = dominant follicle.
  • >3 cm = cyst.

Question 4

Imaging features of simple cysts

Answer 4

Question 5

Hemorrhagic ovarian cysts

Answer 5

Question 6

Complex ovarian cyst

Answer 6

What you call if it you are unsure if it is hemorrhagic on ultrasound

A follow-up examination in 6 weeks will allow for the patient to be at a different phase of the menstrual cycle

Question 7

Rules of pelvis imaging

Answer 7

Question 8

Endometrial stripe thickness in premenopausal women

Answer 8

• During menstruation: 2-4 mm
• Early proliferative phase (day 6-14): 5-7 mm
• Late proliferative / preovulatory phase: up to 11 mm
• Secretory phase: 7-16 mm
• Following dilatation and curettage or spontaneous abortion: <5 mm, if it is thicker consider retained products of conception

Question 9

Endometrial stripe thickness in postmenopausal women

Answer 9

• Vaginal bleeding (and not on tamoxifen):
  
  • < 5 mm is resassuring against carcinoma
  • > 5mm is ~7% risk of carcinoma
• No history of vaginal bleeding:
  
  • < 8-11 mm is resassuring against carcinoma
  • > 11 mm is ~7% risk of carcinoma
• On tamoxifen:
  
  • < 5 mm is resassuring against carcinoma, though as many as 50% have thickness > 8 mm

Question 10

What is more common: Left DVT, or right DVT?

Answer 10

Left DVT, due to May Thurner syndrome – compression by the iliac arteries

Question 11

How to approach pelvic US in HCG+ patient

Answer 11

1. See if there is an intrauterine pregnancy
2. Examine for any extrauterine mass that is not an ovary – these are ectopic pregnancy until proven otherwise
3. Examine the ovaries

Question 12

If HCG is > 3000. . .

Answer 12

. . . you should see an intrauterine pregnancy

If you don’t, it’s either ectopic or miscarriage

Question 13

Tubal ring of fire sign

Answer 13

“Ring of fire” flow seen in the adenxa on ultrasound

Highly suspicious for ectopic pregnancy