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.
Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core consisting of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessel...
Bartholin gland tumours include:
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
There are a number of benign metastasising tumours:
benign metastasising meningioma 1,2
benign metastasising leiomyoma 3
primary adenoma of thyroid 4
giant cell tumour of bone 5
Body packing refers to the internal concealment of drugs within the gastrointestinal tract or other orifices. People who do this may be called body packers, (drug) mules, stuffers, couriers or swallowers. Drugs may be concealed within condoms, foil, latex or cellophane.
There is ...
Serum CA-125 is well recognised as an ovarian cancer-associated marker and is an antigen determinant on a high-molecular-weight glycoprotein. The normal range of CA-125 is 0-35 U/mL.
Serum CA-125 levels can also be used to monitor the response to treatment as well as a prognostic indicator sinc...
Cervical incompetence refers to a painless spontaneous dilatation of the cervix, and is a common cause of 2nd trimester pregnancy failure.
The estimated incidence varies geographically and generally thought to be around 1-1.5% of all pregnancies 1,15.
There are many signs in radiology that are related to Christmas:
snowcap sign in avascular necrosis
in total anomalous pulmonary venous return
in pituitary macroadenomas
snowstorm appearance in complete hydatidiform and testicular microlithiasis
holly leaf sign in calcified pl...
A cystic retroperitoneal lesion can carry a relatively broad differenital which includes:
retroperitoneal cystic lymphangioma
retroperitoneal mucinous cystadenoma
retroperitoneal cystic teratoma
retroperitoenal cystic mesothelioma
pseudomyxoma retroperitonei with cystic change
The cul-de-sac, also known as the pouch of Douglas or rectouterine pouch, is an extension of the postero-inferior reflection of the peritoneal fold between the uterus (anteriorly) and rectum (posteriorly). It is the most inferior aspect of the peritoneal cavity and therefore the first location w...
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...
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 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.
They are typica...
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...
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
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):
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...
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...
Infertility is common, affecting 15-20% of couples, and is defined as the inability to conceive after one year of unprotected intercourse in the fertile phase of the menstrual cycle 3. It can be due to a variety of both female and male factors, and these are discussed in separate articles:
It is important to have a systematic way of approaching a case with subfertility in the exam.
Ultrasound is the initial examination of choice. Always say that you would further assess the uterus with 3D ultrasound. You may also say that in my department we would perform a sonohysterogram or HS...
Intra-uterine contraceptive devices (IUCD) are one of the most frequently used methods of contraception throughout the world. It prevents pregnancy by:
thinnning the endometrial lining
preventing sperm motility
There are two main types of IUCDs:
IUCD 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.
Perforation at the time of insertio...
A large for date uterus is a clinical observation based on uterine fundal height, which may result in referral for ultrasound assessment, usually in mid to late pregnancy.
constitutionally large fetus
Malignant neoplasms involving the uterus account for a significant proportion of all female cancers.
They can be classified as:
endometrial carcinoma : commonest: >90% of all uterine malignancies
endometrioid carcinoma of the uterus: commonest histological type, ~80%
papillary serous 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.
Myometrium cysts are cysts seen in the myometrium and these can be differentiated appropriately based on location and sonological or Doppler features.
adenomyosis: the cysts are most often seen in the endomyometrial junction region. They ideally are small <5 mm, however ma...
A narrow fetal thorax on antenatal ultrasound can be present with a number of anomalies which include:
Jeune syndrome - asphyxiating thoracic dysplasia
short rib polydactyly syndr...
Ovarian cystic neoplasms can be either benign or malignant and can arise from epithelial, stromal, or germ cell components. In general, the risk of malignancy in unilocular cystic tumours <10 cm in women over the age of 50 years is thought to be low 3-4.
ovarian mature cystic teratoma
A hypointense ovarian lesion on T2 weighted MRI is usually a sign of benignity. The low signal is considered to be due to fibrosis and blood products 1.
Lesions that can give this appearance include 1:
Ovarian tumours are relatively common and account for ~6% of female malignancies. This article focuses on the general classification of ovarian tumours. For specific features, refer to the sub-articles.
Primary ovarian tumours
Surface epithelial stromal ovarian tumours (60...
There are several ovarian tumours associated with endometrial thickening and is often due to oestrogenic effects of the ovarian tumour.
Such tumours include:
ovarian epithelial tumours
endometroid carcinoma of the ovary
may have synchronous endometrial carcinoma or endometrial hyperplasia, p...
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...
It is important to have a systematic way of approaching a case with pelvic pain in the exam.
Most examinations are performed using ultrasound. Always say that you would further assess the uterus with 3D ultrasound. You may also say that in my department we would perform a sonohysterogram. Only...
Perigestational haemorrhage refers to haemorrhage that occurs around the fetus during the gestational period. The spectrum of haemorrhage includes:
chorionic haemorrhage: caused by the separation of the chorion from the endometrium
subchorionic haemorrhage: most common type, occurs between th...
It is important to have a systematic way of approaching a case with per vaginal bleeding in the exam.
intrauterine fetal demise
Phocomelia is an extremely rare congenital skeletal disorder that characteristically affects the limbs. It can affect either the upper limbs or lower limbs or both. Phocomelia is also a descriptive term to describe the characteristic limb anomalies occurring with its associated conditions.
Placentomegaly is a term applied to an abnormally enlarged placenta.
It can be associated with number of maternal and fetal disorders which include:
chronic intrauterine infections
Polyhydramnios refers to a situation where the amniotic fluid volume is more than expected for gestational age.
It is generally defined as:
amniotic fluid index (AFI) > 25 cm
largest fluid pocket depth (maximal vertical pocket (MVP)) greater than 8 cm 6: although some centres particularly in ...
Primary peritoneal neoplasms comprise of an uncommon group of heterogenous entities.
The list includes:
primary (malignant) peritoneal mesothelioma
primary perioneal multicystic mesothelioma
primary peritoneal well differentiated papillary mesothelioma
A pyometrium refers to infection of the endometrial cavity with resulting expansion due to accumulated pus.
endometritis / pelvic inflammatory disease
retained products of conception
Rhizomelic dwarfism is a type of dwarfism where the dominant feature is proximal (i.e. femoral, humeral) limb shortening.
The following conditions fall under the heading of rhizomelic dwarfism 3
rhizomelic chondrodysplasia punctata
Right iliac fossa mass is a common clinical presentation and has a range of differentials that need to be excluded. Radiology plays an important role in this differentiation.
Shorted fetal femur is a morphological descriptor and is usually defined when the femoral length falls below the 5th centile for gestational age (some define it when its under the 2.5th centile 5) or less than 0.91 predicted by the bi-pareital diameter. It can occur in isolated or in association...
Short umbilical cord has been variably defined. Considering the mean length of the umbilical cord is 50-70 cm 1-2, a short cord in absolute terms is usually taken as one that is under 35-40 cm in length at term 1-2.
Recognised associations include
A Sister Mary Joseph nodule is a metastatic lesion involving the umbilicus. The most common primary source is an intra-abdominal adenocarcinoma.
Umbilical metastases are uncommon, reportedly present in 1-3% of all intra-abdominal and/or pelvic malignancy 7.
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...
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...
Uterine enlargement can occur in a number of situations from both diffuse and focal processes. These include:
gestation related events
normal intrauterine pregnancy
molar pregnancy - gestational trophoblastic disease
postpartum uterus - still larger than usual
Vulval neoplasms are rare and mostly seen in an elderly female patients. Squamous cell carcinoma is most common malignancy of the vulva which only 30% of them are associated with oncogenic HPV viruses.
Squamous neoplastic lesions
classic vulvar intraepithelial neopla...