Endometrial atrophy is a response to a hypo-oestrogenic state. If it occurs after menopause it can be more specifically termed postmenopausal endometrial atrophy.
While most patients are asymptomatic, endometrial atrophy is one of the commonest cause of postmenopausal bl...
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 ...
Endometrial carcinoma staging allows appropriate treatment options to be considered and enables greater prognostic accuracy for endometrial carcinoma.
Staging can be based on the TNM or FIGO system.
MR imaging is the modality of choice for staging with CT having relatively low speci...
Fluid in the endometrial cavity can result from a number of causes if excessive and associated with distension.
There are essentially three types of fluid:
hydrometra: simple fluid
haematometra: haemorrhagic content / clot
normal (i.e. physiological...
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.
Endometrial microcalcifications can arise from a vast range pathologies but are usually of benign in aetiology.
They have an increased incidence with older age, postmenopausal state, atrophic endometrium, and endometrial polyps.
In some cases they are associated wi...
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...
Getting a film with endometrial polyp in the exam is one of the many exam set-pieces that can be prepared for.
Transabdominal and transvaginal pelvic ultrasound images in a lady with post-menopausal bleeding show an anteverted uterus with focal increased endometrial thickness to 1...
Endometrial reflectivity grading on ultrasound is a system initially proposed by Smith et al. in 1984 which classifies the endometrium into four types according to the echotexture pattern. They are considered to be useful in deciding on receptivity in in-vitro fertilisation (IVF).
The Smith sys...
Endometrial stromal tumours (EST) are an uncommon group of tumours arising from endometrial stromal cells. It accounts for <2% of all uterine malignancies and 10% of all uterine sarcomas.
Half occur in premenopausal women, with most patients presenting in the 5th decade.
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...
Endometrioid carcinoma of the endometrium is the most common histological subtype of endometrial carcinoma accounts for 85-90% of cases. It is considered a type I carcinoma of the uterus with slow progression and relatively good prognosis. Patients are usually 55 to 65 years old.
Endometrioid carcinoma of the cervix is a rare histological subtype of cervical cancer. It falls under the sub group of adenocarcinoma of the cervix.
It is thought to account for approximately 7% of cervical adenocarcinomas 2-3. The incidence is thought to have increased through ...
Endometrioid carcinomas of the ovary are a sub-type of epithelial ovarian tumours. The vast majority are malignant and invasive. On imaging, they are usually characterised as complex nonspecific solid-cystic masses and found associated with endometriosis.
Endometrioid carcinomas ...
Endometriomas, also known as chocolate cysts or endometriotic cysts, are a localised form of endometriosis and are usually within the ovary. They are readily diagnosed on ultrasound, with most demonstrating classical radiographic features.
These occur women of reproductive age.
Endometriosis is a common and clinically important problem in women of childbearing age. It is classically defined as the presence of functional endometrial glands and stroma outside the uterine cavity and its musculature 1. This is distinct from adenomyosis, in which endometrial tissue is confi...
Endometriosis affecting the canal of Nuck is an extremely rare site for endometriosis. It is proposed that retrograde implantation of endometrial tissue into patent canal of Nuck could give rise to the condition.
The condition is presented as a painful inguinal swelling. ...
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....
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...
Ovarian epithelial tumours account for the majority of all ovarian tumours (60-70%) and their malignant forms represent >90% of ovarian cancers 1. They can range from being benign to highly malignant.
There is a difference in frequency of ovarian tumour subtypes depending on menop...
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...
Extra-uterine pelvic leiomyomas are much rarer than the typical uterine leiomyomas.
Entities that are described in this group include
cervical leiomyoma: sometimes classified as part of uterine leiomyomas
vaginal leiomyoma: extremely rare
benign metastasising leiomyoma in the pelvis
Fallopian tube rupture is most often a complication of a tubal ectopic pregnancy where the pregnancy breaks open due to progressive growth. It can potentially lead to shock.
Factors that raise the risk for a tubal rupture in a given tubal ectopic pregnancy include 2-4:
A Fallopian tube polyp refers to a small focal lesion of ectopic endometrial tissue located at the intramural portion of the fallopian tube.
The reported incidence is 1- 2.5% on hysterosalpingograms performed for assessment of infertility 3
Most patients w...
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.
Fallopian tube spasm is a transient functional anomaly that can mimic a true mechanical tubal occlusion. At radiography, tubal spasm cannot be distinguished from a tubal occlusion. Administration of spasmolytic agents such as glucagon can occasionally result in uterine muscle relaxation and cons...
Fallopian tube torsion is a type of adnexal torsion and usually occurs in association with an ovarian torsion (when it is then termed a tubo-ovarian torsion). An isolated fallopian tube torsion is rare but can occur.
An isolated tubal torsion can occur as a late complication of tuba...
Female infertility is common, and can be due to a number of factors. Radiology often plays a key part of the work-up.
Often more than one factor (including male infertility) is the cause of infertility, some of the common causes are listed below 1-3:
age > 35 years
Female pseudohermaphroditism (FPH) is a form of disorder of gender development.
Patients with female pseudohermaphroditism have female internal genitalia and female karyotype (XX) with various degree of external genitalia virilization.
congenital adrenal hyperplasia (CAH) ...
The female reproductive system (or tract) comprises the vagina, uterus, uterine tubes and ovaries.
It can be imaged using a wide range of imaging modalities but ultrasound and MRI are most useful.
The mnemonic used in the FIGO classification system for the causes of abnormal uterine bleeding in non-gravid women of reproductive age is 1:
The "PALM" causes are considered structural and the "COEIN" (coin) causes are considered non-structural.
The FIGO staging systems are determined by the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d’Obstétrique).
In general, there are five stages:
stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer)
stage I: confined to...
A fimbrial ectopic pregnancy is a sub type of tubal ectopic pregnancy. This sub type accounts for ~ 5 -11% 1,3 of all tubal ectopic pregnancies. In a fimbrial ectopic, the implantation is at the fimbria of the fallopian tube which is closest to the ovary. The chance of a tubal rupture is compara...
Fitz-Hugh-Curtis syndrome (FHCS) refers to the development of a perihepatitis in association with pelvic inflammatory disease (PID).
The prevalence in adults with mild to moderate PID (gonorrhoic) may approximate 4% 10. The prevalence may be higher in genital tuberculosis 12. It ...
Focal adenomyosis is a morphological subtype of adenomyosis.
Some authors regard this term synonymous with an adenomyoma.
It is considered less common than diffuse uterine adenomyosis 4.
Focal adenomyosis most commonly occurs at the fundal endometrial-myo...
Follicular monitoring or follicular study is a vital component of in-vitro fertilization (IVF) assessment and timing. It basically employs a simple technique for assessing ovarian follicles at regular intervals and documenting the pathway to ovulation.
Journey to ovulation begins d...
The term fornix (plural: fornices) is used for anatomical structures in multiple organ systems that all share an arch-like morphology:
History and etymology
Fornix is Latin for...
The fornices are superior recesses of the vagina formed by the protrusion of the cervix into the vaginal vault. There is a large posterior fornix and a smaller anterior fornix with two small lateral fornices.
History and etymology
Fornix is Latin for 'arch'.
Fowler syndrome is a rare condition characterised by
brain stem and basal ganglion calcification
glomeruloid (proliferative) vasculopathy of cerebral vessels
fetal akinesia deformation sequence with muscular hypoplasia
Sometimes a separate condition resulting in urinary re...
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...
Frontal bossing is a calvarial radiographic feature where the front of the skull appears protruding anteriorly. It is best appreciated on a sagittal or lateral image.
This feature can be seen in many conditions (in alphabetical order):
Frontonasal dysplasia, also known as median cleft face syndrome, is a rare disorder characterised by midline defects involving the face, head, and central nervous system.
Frontonasal dysplasia is considered to be a very rare condition, with approximately 100 cases having been repo...
Fryns syndrome (FS) is a rare congenital disorder which can have significant phenotypic variability but is primarily characterised by cranio-facial anomalies, diarphagmatic defects and distal limb anomalies.
Incidence is estimated at 1:15,000 live births.
A functional ovarian cyst is a term given to a group of non neoplastic type of ovarian cysts. A large proportion of ovarian cysts detected on imaging are functional ovarian cysts. Entities that fall under this group include
ovarian follicular cysts
corpus luteum cysts
theca lutein cysts
Cervical funnelling is a sign of cervical incompetence and represents the dilatation of the internal part of the cervical canal and reduction of the cervical length.
Greater than 50% funnelling before 25 weeks is associated with ~80% risk of preterm delivery.
Gartner duct cysts develop from embryologic remnants of the Wolffian (mesonephric) duct. They are often noticed incidentally on ultrasound or MRI.
They may cause mass effect on adjacent structures.
Gartner duct cysts are located in the anterolateral ...
Germ cell tumours are found widely throughout the body, and encompass a wide range of individual tumours.
This article does not deal with any specific body locations. For detailed discussion please refer the articles listed at the end of this page.
Germ cell tumours arise from ecto...
A mnemonic for differential diagnosis for germ cell tumours is:
E: embryonal cell carcinoma
E: endodermal sinus tumour (yolk sac tumour)
Germ cells tumours of the ovary account for approximately 15-20% of all ovarian tumours. In children and adolescents, up to 60% of ovarian tumours can be of germ cell origin.
ovarian teratoma(s): commonest primary benign tumour of ovary and commonest germ cell tumour:
Germinoma is a term that if unqualified, usually refers to a tumour of the brain but can also refer to similar tumours of other regions particularly the ovary and testis.
dysgerminoma of the ovary
seminoma of the testis
CNS germinoma: see WHO classification of CNS tumours
All these tumours s...
Gestational choriocarcinoma (GC) is a type of choriocarcinoma that follows a gestational event. Similar to choriocarcinomas in general, it lies at the malignant end of the spectrum of gestational trophoblastic disease.
Approximately 50% of gestational choriocarcinomas arise from a pr...
Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including:
coexistent molar pregnancy
invasive mole ~10%
choriocarcinoma (gestational choriocarc...
Gigantomastia (also known as macromastia or mammomegaly) is the term employed when there is massive breast enlargement. It is often associated with pregnancy. It may be rarely unilateral.
Gigantomastia is a very common condition characterised by proliferation of either breast fatty tissue or gl...
The gonadal arteries are the paired primary vascular supply to the ovaries in the female and the testes in the male. As the anatomy of the gonadal arteries differs substantially between the sexes, they are covered separately:
Gonadal dysgenesis refers to a spectrum of anomalies with abnormal development of the gonads. It falls under the even broader group of disorders of gender development.
In many cases the gonads are replaced by fibrous tissue.
complete gonadal dysgenesis (CGD) / Swyer syndro...
Goodman syndrome is a type of acrocephalopolysyndactyly (often considered type IV). It is an extremely rare genetic disorder characterized by marked malformations of the head and face, abnormalities of the hands and feet, and congenital heart disease. The syndrome is inherited as an autosomal re...
Granulosa cell tumours of the ovary are a type of sex cord / stromal ovarian tumour.
Sex cord-stromal tumours represent approximately 8% of all ovarian tumours and are believed to arise from and/or to contain combinations of the sex cord and stromal components of the developing go...
The clinical history will nearly always lead to a short differential or the answer. Show off to the examiner that you have a structured approach to reporting and managing the patient.
uterus: size, version and shape (normal or variant which you should elaborate on and say w...
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...
The gynaecology curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core gynaecological knowledge.
Topics pertaining to the ovaries, uterus, vagina and associated stuctures, but excluding those specific to obstetrics and urinary sy...
A habitual miscarriage is the term given when a woman has had more than 3 miscarriages and it affects approximately 1-2% of women.
Many causes are identified.
mullerian duct anomalies
acquired uterine causes
uterine adhesion bands
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...
A haematometrium refers to a uterus filled with blood.
pyometrium: uterus filled with pus
haematometrocolpos: uterus and vagina filled with blood
hydrometrium: uterus filled with fluid
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...
A haematosalpinx refers to intraluminal blood within the Fallopian tube (often dilated).
tubal ectopic pregnancy: common cause 1
endometriosis: common cause 5
pelvic inflammatory disease
fallopian tube torsion
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...
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 ...
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...
Hemimegalencephaly is a rare congenital disorder of cortical formation with hamartomatous overgrowth all or a part of a cerebral hemisphere. This results from either increased proliferation or decreased apoptosis (or both) of developing neurons 2.
Hemimegalencephaly is a cryptogen...
Hereditary breast and ovarian cancer (HBOC) syndrome is caused by a mutation to either BRCA1 or BRCA2 genes. These patients have an increased risk of breast cancer, ovarian cancer, pancreatic cancer and prostate cancer. However, these gene mutations are not the only cause of hereditary breast ca...
Herlyn-Werner-Wunderlich (HWW) syndrome, is a rare anomaly characterised by Müllerian duct anomalies (MDA) associated with mesonephric duct anomalies 3. This entity is also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). It is not to be confused with the Wunderlich syndro...
A heterogeneous myometrial echotexture on ultrasound can be non specific finding although it has been described with uterine adenomyosis.
Human epididymis protein 4 (HE4) is an emerging serum biomarker in the assessment of epithelial ovarian tumours. HE4 is a member of the whey associated protein (WAP) gene cluster and has uncertain biological function 1.
Early results indicate that HE4 has higher sensitivity and sensitivity than...
Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma.
It is thought to occur in up to 60% of uterine leiomyomas 3.
As with many other types of degeneration, it happens when fibroids outgrow their blood supply 4. Hyaline de...
Hydatidiform moles are one of the most common but benign forms of the gestational trophoblastic disease.
It is a common complication of gestation, estimated to occur in one of every 1,000-2,000 pregnancies 3. These moles can occur in a pregnant woman of any age, but the rate of o...
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...
Hydrocolpos is characterised by an expanded fluid filled vaginal cavity. When it is associated with distention of the uterine cavity, the term hydrometrocolpos should then be used. It may present in infancy with a lower abdominal mass, or be delayed till menarche.
Hydrolethalus syndrome is a rare lethal genetic syndrome characterised by multiple developmental defects of fetus which include
cleft lip + / - palate
agenesis of the corpus callosum
absent midline stru...
Hydrometra is a descriptive term that refers to a distended uterus filled with clear, non-infected fluid.
Hydrometrocolpos is characterised by an expanded fluid filled vaginal cavity with associated distention of the uterine cavity. It may present in infancy with a lower abdominal mass, or be delayed till menarche.
imperforate hymen (most common) also involves the upper portio...
Hydropic degeneration of the placenta is a phenomenon where numerous cystic spaces are formed within the placenta which is often accompanied by placental enlargement. It can occur in a number of situations which include
simple hydropic degeneration in 1st trimester pregnancy loss - fetal demise...
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...
The hymen (plural: hymens) 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 ar...
Hyperechoic myometrial foci are sonographic observation where the myometrium contains numerous bright echogenic foci.
They can be observed in very different situations and the clinical context is vital in their interpretation.
Recognised causes include
There are several hypertensive states that can manifest in pregnancy. They include:
gestational hypertension - pregnancy induced hypertension (PIH)
They may be commoner in young primigravid as well as older multiparous women.
A hypocoiled umbilical cord to an umbilical cord with less than normal coiling. This is normally estimated by a low umbilical cord coiling index (usually less than 0.2 2).
single umbilical artery
abnormal cord insertion(s)
non coiled umbilical cord
Hypophosphatasia refers to a rare metabolic disorder characterised by deficient serum alkaline phosphatase activity. The effects of hypophosphatasia are primarily seen in the skeletal system. The condition has marked variation in clinical expression (see subtypes).
The true incide...
Hysterosalpingogram (HSG) is a fluoroscopic examination of the uterus and the Fallopian tubes, most commonly used in the investigation of infertility or recurrent spontaneous abortions.
Infertility to assess uterine morphology and tubal patency.
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 ...
Ileal atresia is a congenital abnormality where there is significant stenosis or complete absence of a portion of the ileum. There is an increased incidence in those with chromosomal abnormalities.
This article will focus on ileal atresia alone but bear in mind that some cases correspond to jej...
Immature ovarian teratomas are uncommon ovarian germ cell tumours. They differ from mature ovarian teratomas (dermoid cysts) both histologically by the presence of immature tissue, and clinically by their more malignant behaviour.
They are considerably less common than mature ovar...
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 c...
An incarcerated uterus or trapped uterus describes an extremely rare situation where a retroverted or retroflexed gravid uterus fails to ascend into the abdominal cavity.
This is an uncommon presentation and is said to occur in 1 in 3000 pregnancies. Uncomplicated retroversion may...