Myxoid uterine leiomyomas are a relatively rare pathological subtype of uterine leiomyomas.
They are not to be confused with myxoid degeneration of a uterine leiomyoma which is a different entity.
Myxoid leiomyomas contain abundant myxoid material between smooth muscle ...
Vaginal leiomyomas are an extremely rare entity and fall under extra-uterine pelvic leiomyomas.
They are extremely rare with only ~ 300 cases reported in literature 3.
It may occur anywhere along the vaginal canal and is usually localized, mobile, non-tender, and circ...
Benign metastasising leiomyomas are a rare metastatic phenomenon that is observed when a pelvic leiomyoma is present.
Women who have undergone hysterectomy for leiomyomas are most commonly affected.
Patients are usually asymptomatic at presentation. A histo...
Intravenous leiomyomatosis (IVLM) is characterised by the extension into venous channels of histologically benign smooth muscle tumour arising from either the wall of a vessel or from a uterine leiomyoma.
Intravenous leiomyomatosis should not be confused with benign metastasising l...
Leiomyomas of the uterine cervix are an unusual variation in terms of location for a uterine leiomyoma.
They are rare and account for ~5% (range 0.6-10%) of uterine leiomyomas 1,4.
Clinical symptoms of cervical leiomyomas, including hypermenorrhea, dysmenor...
Parasitic leiomyomas are considered a type of extra-uterine leiomyoma and present as peritoneal pelvic benign smooth-muscle masses separate from the uterus.
It likely originates as a pedunculated subserosal leiomyoma that twists and torses from its uterine pedicle. The contact with ...
Broad ligament leiomyomas are extra-uterine leiomyomas that occur in relation to the broad ligament.
Broad ligament leiomyomas are also referred as a type of parasitic leiomyomas 5.
While in most cases broad ligament leiomyomas are asymptomatic, patients ma...
Subserosal uterine leiomyoma is a subtype of uterine leiomyoma that often exophytically projects outwards from a subserosal location. While its exact definition may vary, a leiomyoma is often called subserosal if >50% of the fibroid protrudes out of the serosal surface of the uterus 2.
Intramural uterine leiomyoma is the most common type of uterine leiomyoma in terms of location. They are centred primarily within the myometrium. A large intramural uterine leiomyoma can, however, have a submucosal or subserosal component.
They are usually asymptomatic; h...
The bridging vessel sign refers to an appearance of vessels coursing from the uterus into an adjoining pelvic mass (a vascular bridge). This sign helps to differentiate a pedunculated subserosal uterine leiomyoma from other juxtauterine masses of ovarian, adnexal or bowel origin.
Colour and pow...
Diffuse or disseminated peritoneal leiomyomatosis, also known as leiomyomatosis peritonealis disseminata, is an exceedingly rare benign disorder characterised by multiple vascular leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum.
It is usually d...
Submucosal leiomyomas of the uterus refer to a subtype of uterine leiomyoma that primarily projects into the endometrial cavity. They are least common albeit the most symptomatic type of leiomyoma.
Submucosal leiomyomas can be a common source of abnormal uterine bleeding ...
The ovaries are paired female gonads of the reproductive and endocrine systems. They lie within the ovarian fossa on the posterior wall of the true pelvis.
The ovaries are ovoid in shape and measure approximately 1.5-3.0 cm x 1.5-3.0 cm x 1.0-2.0 cm (length x width x thickness) ...
Choriocarcinoma is an aggressive, highly vascular tumour. When it is associated with gestation, it is often considered part of the spectrum of gestational trophoblastic disease; it is then termed gestational choriocarcinoma. When it occurs in the absence of preceding gestation, it is termed non-...
Endometrial hyperplasia is abnormal proliferation of the endometrial glands and stroma, defined as diffuse smooth thickening >10 mm 13. One of the main concerns is the potential malignant transformation of the endometrial hyperplasia to endometrial carcinoma.
Obstetric and gynaecological ultrasound is rampant with numerous cut off values. Some of these get revised over the years. The following list is a useful aid to refer to and revise.
rate of increase of a mean sac diameter per day in early pregnancy
generally accepted value for a th...
Pelvic masses in females carry a broad differential diagnosis:
benign adnexal cyst: 34%
pelvic malignancy: 14%
pelvic inflammatory disease: 8%
Extra-gynaecological masses, e.g. colorectal carcino...
Metastases to the ovary are relatively common with a documented incidence of 5-30% of all malignant ovarian masses.
These may be incorrectly grouped under Krukenberg tumors, which are signet cell containing tumours that form only 30-40% of all ovarian metastases.
A bicornuate uterus is a type of uterine duplication anomaly. It can be classified as a class IV Mullerian duct anomaly.
Overall, congenital uterine anomalies occur in ~1.5% of females (range 0.1-3%). Bicornuate uteri are thought to represent ~25% (range 10-39%) of Mullerian duct ...
Uterus didelphys is a type of Müllerian duct anomaly (class III) where there is a complete duplication of uterine horns as well as duplication of the cervix, with no communication between them.
Didelphic uteri account for approximately ~8% (range 5-11%) of Müllerian duct anomali...
IUCD (Intrauterine contraceptive device) related uterine perforations are one of the causes of uterine perforation. It is rare, but a serious complication of an IUCD insertion, and is often clinically silent.
The incidence rate is reported at ~2 in 1000 2.
Intra-uterine contraceptive devices (IUCD) are one of the most frequently used methods of contraception throughout the world. It prevents pregnancy by:
thinning the endometrial lining
preventing sperm motility
There are two main types of IUCDs:
non-hormonal metallic ...
Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including:
invasive mole ~10%
choriocarcinoma (gestational choriocarcinoma) ~1%
placental site t...
Coexistent molar pregnancy refers to an extremely rare situation where there is a molar pregnancy occurring simultaneously with normal intra-uterine pregnancy.
The estimated incidence is at ~1:10,000-100,000 gestations (for a complete hydatidiform mole and a normal pregnancy) 2.
Scar endometriosis is a term given to endometriosis occurring in a Caesarian section scar. It can be located in the skin, subcutaneous tissue, rectus muscle/sheath, intraperitoneally, or in the uterine myometrium (within uterine scar).
The reported incidence of abdominal scar endo...
True hermaphroditism is a form of disorder of gender development.
Patients with true hermaphroditism have mosaicism of 46XX and 46XY. They therefore have both ovarian and testicular tissues.
There are three forms of true hermaphroditism:
unilateral true hermaphroditism
MR defaecography is a dynamic study for evaluation of the pelvic floor and pelvic organ prolapse.
There are four phases of evaluation:
Method of evaluation
Many variations in the techniques described below exist.
Syndactyly refers to a congenital fusion of two or more digits. It may be confined to soft tissue (soft tissue syndactyly / simple syndactyly) or may involve bone (bony syndactyly / complex syndactyly).
The overall estimated incidence is at ~1 per 2500 to 5000 live births 6,8. The...
Haemorrhagic ovarian cysts (HOCs) usually result from haemorrhage into a corpus luteum or other functional cyst. Radiographic features are variable depending on the age of the haemorrhage. They typically resolve within eight weeks.
Patients may present with sudden-onset ...
Haemorrhagic corpus luteal cysts result from bleeding into corpus luteal cysts.
Commonly described findings include:
complex adnexal mass
adnexal thick-walled cystic lesion with lace-like strands
adnexal thick-walled cystic lesion with low-level echoes with...
Haematocolpos is a term given to a blood-filled dilated vagina due to menstrual blood in the setting of an anatomical obstruction, usually an imperforate hymen. When there is concurrent uterine distention, the term haematometrocolpos is used.
Patients may present with ame...
Tubo-ovarian abscesses (TOA) are one of the late complications of pelvic inflammatory disease (PID).
Associated risk factors include 15:
presence of intrauterine device
multiple sexual partners
Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.
It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. It is a gynaecological ...
Ruptured ovarian cysts are one of the most common causes of acute pelvic pain in premenopausal women. The sonographic appearance depends on whether a simple or haemorrhagic ovarian cyst ruptures, and whether the cyst has completely collapsed. The most important differential consideration is a ru...
The vestibule of the vulva (vestibule of the vagina in some texts 2) is the area between the labia minora, and posterior to the glans of the clitoris. It marks the boundary between the vagina and the vulva. The urethra, vagina and the greater vestibular glands open out into the vestibule.
The labia minora (singular: labium minus) are small glabrous cutaneous folds lying between and just superior to the labia majora. At their posterior margin the labia may be conjoined by a thin cutaneous fold of skin, the frenulum of the labia (also known as the fourchette).
At their anterior m...
The hymen is a thin fold of mucous membrane which extends across the vaginal opening, usually with some form of internal defect, which permits the free passage of normal menses.
It usually ruptures during coitus with the remnants, usually in the form of small tags of tissue around the vaginal ...
The vagina is a midline fibromuscular tubular organ positioned in the female perineum extending superiorly from the vulva, to the cervix and uterus in the pelvis.
The vagina is 8-10 cm in length, extending posterosuperior from the vestibule through the urogenital diaphragm to th...
The vulva (or pudendum) is the collective term given to the female external genitalia.
The vulva consists of the:
vestibule of the vulva
Individual component st...
Paraurethral duct cysts are retention cysts that form secondary to inflammatory obstruction of the paraurethral (Skene) ducts in females.
The cysts are lined by stratified squamous epithelium due to their origin from the urogenital sinus.
The Bartholin glands (or greater vestibular glands) are paired pea-sized structures, lying on either side of the vaginal opening, and are homologous to the bulbourethral (Cowper) glands in the male. They form part of the vulva.
These glands are described as less than 1 cm in diam...
Imperforate hymen is a congenital condition in which the hymen lacks a normal opening.
It happens in 0.1% of the female population, usually an isolated finding.
Primary amenorrhea with cyclic lower abdominal pain during menarche age. An imperforate hymen can b...
A vestibule is an anatomical term and refers to a small cavity at the proximal end of a tube.
History and etymology
Vestibule derives ultimately from the Lati...
Frenulum (plural: frenula) is an anatomical term and refers to a small fold of soft tissue that checks the movement of an anatomical part.
frenulum (ileocaecal valve)
frenulum (labia minora)
History and etymology
Frenulum derives from...
The mons pubis (plural: montes pubis) refers to the rounded protuberant skin-covered soft tissue overlying the symphysis pubis (in both sexes). It is most prominent in adult females.
In females it forms the most superior part of the vulva and it is also called the mons Veneris (plural: montes V...
The labia majora (singular: labium majus) form the anteroinferior most part of the vulva, they are continuous with the mons pubis anteriorly and the perineum posteriorly. The labia are apposed in the midline forming the, externally-visible, pudendal cleft.
The labia majora have a...
Diffuse uterine adenomyosis is the most common of uterine adenomyosis. For the discussion of adenomyosis, please refer to the parent article - adenomyosis of the uterus.
Diffuse adenomyosis may account for ~2/3rd of uterine adenomyosis.
Diffuse adenomyosis can be even ...
The paraurethral ducts (or Skene ducts) drain the paraurethral glands of the female urethra. There is one duct, draining each gland, on each side, just proximal to the external urethral meatus.
paraurethral duct cyst
paraurethral duct abscess
Hydrocele of the canal of Nuck is a rare condition in female children caused by a failure of complete obliteration of the canal of Nuck 1. The canal of Nuck is an abnormal patent pouch of peritoneum extending anterior to the round ligament of the uterus into the labia majora 2. Incomplete oblite...
The perineum is a diamond shaped region below the pelvic diaphragm and is divided by an imaginary line drawn between the ischial tuberosities into anteriorly the urogenital triangle and posteriorly the anal triangle.
The perineum is bounded by the pubis anteriorly, the ischial tu...
Vesicovaginal reflux is a well-known entity rarely encountered by radiologists. It is a behavioural disorder, a type of dysfunctional elimination syndrome commonly encountered in pre-pubertal girls. It is defined as reflux of urine into the vaginal vault either in supine or upright position duri...
Primary vulval cancer is a rare gynaecological malignancy that originates from the vulva.
It accounts for ~3-5% of female genital tract malignancies and typically presents in postmenopausal patients peaking around the age of 65-70 years of age 1.
The commonest histolo...
The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora through the inguinal ring into the inguinal canal. Incomplete obliteration of this canal is known as a patent processus vaginalis and can result i...
The urogenital triangle forms the anterior half of the diamond-shaped perineum. The triangle's corners are defined by the pubis symphysis anteriorly and the ischial tuberosities anterolaterally. The anterolateral borders are the ischiopubic rami and the posterior border is the transverse perinea...
Bartholin gland tumours represent neoplasms of the Bartholin glands.
squamous cell carcinoma of the Bartholin gland: tends to be the most common histological subtype
adenocarcinoma of the Bartholin gland
adenoid cystic carcinoma of the Bartholin gland
Bartholin gland cysts are located in the posterolateral inferior third of the vagina and are associated with the labia majora.
Most patients are asymptomatic 4.
infection: may turn into Bartholin gland abscesses
rare instances of development of adenocarc...
Surgical haemostatic material is used to control bleeding intraoperatively and is hence frequently voluntarily left in the operative bed, not to be confused with a gossypiboma which is foreign material left by mistake. It can mimic an abscess on imaging studies. Various types are available, the ...
Hydrosalpinx is a descriptive term and refers to a fluid-filled dilatation of the fallopian tube.
Patients may be asymptomatic or may present with pelvic pain or infertility.
One or both fallopian tubes may be affected. A hydrosalpinx results from an accumula...
Adenomyosis of the uterus is a common, benign uterine pathology. It is thought by many to be on the spectrum of endometriosis, with ectopic endometrial tissue in the myometrium. Adenomyosis may present with menorrhagia and dysmenorrhoea. Ultrasound and MRI are imaging modalities that may show ch...
Abnormally thickened endometrium on imaging may occur for a number of reasons which may be categorised based on whether or not they are related to pregnancy. Aetiologies may also be classified based on whether the patient is premenopausal or postmenopausal.
The claw sign is useful in determining whether a mass arises from a solid structure or is located adjacent to it and distorts the outline.
It refers to the sharp angles on either side of the mass, which the surrounding normal parenchyma forms when the mass has arisen from the parenchyma. As suc...
The endometrium refers to the inner lining of the uterine lumen, composed of endometrial glands surrounded by loose highly cellular connective tissue.
In women of reproductive age, the endometrium is composed of two layers:
stratum basale (basal layer):
describes the de...
The deep perineal pouch is an anatomic space superior (deep) to the perineal membrane in the urogenital triangle of the perineum, anterior to the transverse line between the ischial tuberosities.
The deep perineal pouch is above (deep to) the perineal membrane in the urogenital t...
The superficial perineal pouch is an anatomic space below the perineal membrane in the urogenital triangle of the perineum.
The superficial perineal pouch is inferior (superficial) to the perineal membrane in the urogenital triangle, anterior to the transverse line between the is...
Endometrial ablation is a minimally invasive surgical procedure that involves the destruction of the uterine endometrium commonly performed for menorrhagia in premenopausal or perimenopausal women.
It has evolved has an alternative to hysterectomy and is associated with good outcomes and patien...
Asherman syndrome, also known as uterine synechiae, is a condition characterised by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium, and is often associated with infertility.
There is a tendency for the condition to develop soon af...
Haematometrocolpos refers to a blood-filled distended uterus and vagina usually due to an anatomical mechanical obstruction precluding the evacuation of the menstrual blood.
The estimated incidence in teenagers is at ~1 in 1000-2000 5.
imperforate hymen: in ~2...
Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum haemorrhage.
UAP usually presents as delayed (secondary) postpartum haemorrhage, that is per vaginal bleeding which occurs more than 24 hours and up to 6 weeks postpartum. However, some reported ...
Endometritis refers to inflammation or infection involving the endometrium. Endometritis can be acute or chronic and may arise in an obstetric setting, such as following delivery or miscarriage, or in a nonobstetric setting due to pelvic inflammatory disease (PID) or endometrial instrumentation....
Tamoxifen has pro-oestrogenic effects on the endometrium and thus is associated with an increased prevalence of:
endometrial polyps: occurs in ~8-36% of women in treated 8
endometrial hyperplasia: occurs in ~1-20% of women treated ref
cystic endometrial atrophy
Endometrial thickness is a commonly measured parameter on routine gynaecological ultrasound and MRI. The appearance, as well as the thickness of the endometrium, will depend on whether the patient is of reproductive age or postmenopausal and, if of reproductive age, at what point in the menstrua...
Endometrial polyps are benign nodular protrusions of the endometrial surface, and one of the entities included in a differential of endometrial thickening. Endometrial polyps can either be sessile or pedunculated. They can often be suggested on ultrasound or MRI studies, but may require sonohyst...
Endometrial carcinoma is generally considered the most common gynaecological malignancy 1,5. It frequently presents with vaginal bleeding. Both ultrasound and pelvic MRI are useful modalities for evaluation.
Endometrial carcinoma is the most common gynaecological malignancy, with ...
Ovarian dermoid cyst and mature cystic ovarian teratoma are terms often used interchangeably to refer to the most common ovarian neoplasm. These slow-growing tumours contain elements from multiple germ cell layers and are best assessed with ultrasound.
Although they have very simi...
The vaginal cuff is the remnant tissue after a hysterectomy. The cuff may be evaluated for tumor recurrence (often with ultrasound) if the uterus was removed for cervical or endometrial carcinoma.
The appearance of the cuff depends on what type of hysterectomy was perform...
The Gynecologic Imaging Reporting and Data System (GI-RADS) is a reporting system that was created for reporting the findings in adnexal masses based on transvaginal ultrasonography.
Findings are classified into five categories 1:
normal ovaries identified and no adn...
A useful mnemonic to remember the order of the 5 segments of the Fallopian tube, from lateral to medial, the direction an ovum would pass following ovulation, is:
Four INches Across IS IMpossible
Four inches (10 cm) is the approximate length of the Fallopian tube.
Pelvic congestion syndrome (some prefer pelvic venous insufficiency 9) is a condition that results from retrograde flow through incompetent valves in ovarian veins. It is a commonly missed and potentially-treatable cause of chronic abdominopelvic pain.
It tends to be more common ...
A retroverted uterus is a normal variation of female pelvic anatomy in which the body of the uterus is tilted backwards (usually leans forward, i.e. anteverted) on itself to match the isthmus of the neck and lower uterine segment. There are variable grades of uterine retroversion.
Retained products of conception (RPOC) refer to the persistence of placental and/or fetal tissue in the uterus following delivery, termination of pregnancy or a miscarriage.
Retained products of conception complicate ~1-5% of all pregnancies (routine vaginal deliveries 12).
HELLP syndrome is a pregnancy-related condition and is an abbreviation for:
elevated liver enzymes and
It is considered a severe and life-threatening form of pre-eclampsia although it can occur without co-existing pre-eclampsia.
The estimated inciden...
An epithelioid trophoblastic tumour (ETT) is an extremely rare form of trophoblastic neoplasm. It is considered as a rare subtype of gestational trophoblastic disease 2,4.
It typically presents in women of reproductive age (peak age in late 30's) and can occur between 1 and 18 yea...
Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina.
The overall incidence of vesicovaginal fistula is unknown but was reported to be 2.11 per 100 births in Nigeria 1.
A mnemonic for the contents of the broad ligament is:
B: bundle (ovarian neurovascular bundle)
R: round ligament
O: ovarian ligament
A: artefacts (vestigial structures)
D: duct (oviduct)
The broad ligament is the lateral folds of the parietal peritoneum which reflect over the upper genital tract.
The broad ligament extends from the lateral aspect of the uterus to the lateral pelvic wall and can be divided into three main components - the mesosalpinx, mesovarium a...
Sacrococcygeal teratoma (SCT) refers to a teratoma arising in the sacrococcygeal region. The coccyx is almost always involved 6.
It is the commonest congenital tumour in the fetus 11 and neonate 3. The incidence is estimated at ~1:35000-40000. There is recognised female predilecti...
Nabothian cysts, also known as a retention cysts of the cervix 11, are non-neoplastic cystic lesions that occur in relation to the uterine cervix.
They are common and some reports suggest that they may be seen in up to 12% of routine pelvic MRI scans 2.
Ian Donald (1910-1987) was a Scottish obstetrician who pioneered the diagnostic use of ultrasound in medicine.
Ian Donald was born in Lisgeard, Cornwall, United Kingdom on 27th December 1910 6. His father was a general practitioner. In 1925 his family moved to South Africa where he ...
Abdominal and pelvic anatomy encompasses the anatomy of all structures of the abdominal and pelvic cavities.
This anatomy section promotes the use of the Terminologia Anatomica, the global standard for correct gross anatomical nomenclature.
Tuberculous pelvic inflammatory disease refers to pelvic inflammatory disease due to Mycobacterium tuberculosis.
Genital tract involvement may be present in ~1.5% of cases of those affected with tuberculosis 4.
Infection almost always results from spread from an extrag...
Klinefelter syndrome (KS) is a chromosomal anomaly, which in most cases is characterised by 47 chromosomes instead of the usual 46.
The estimated incidence is 0.15-0.2% of live births.
the testes are normal prior to puberty and small in post pubertal testes...
A Rokitansky nodule or dermoid plug refers to a solid protuberance projecting from an ovarian cyst in the context of a mature cystic teratoma. It often contains calcific, dental, adipose, hair and/or sebaceous components 1.
History and etymology
It is named after Carl von Rokitansky (1804-187...
Short rib polydactyly syndrome(s) (SRPS) comprise a rare group of severe osteochondrodysplasias. There are four major recognised types present:
type I: Saldino-Noonan type
type II:: Majewski type
type III: Verma-Naumoff type
type IV: Beemer-Langer type
There may also be other very rare type...