Articles

Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. As such, articles are written and edited by countless contributing members over a period of time. A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions.

48 results found
Article

Abnormally thickened endometrium (differential)

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. Differential diagnosis Pregnancy-rel...
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Abscess

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...
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Bartholin gland tumours

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
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Benign metastasising tumours

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
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Body packing

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.  Epidemiology There is ...
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CA-125

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...
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Cervical incompetence

Cervical incompetence refers to a painless spontaneous dilatation of the cervix, and is a common cause of 2nd trimester pregnancy failure. Epidemiology The estimated incidence varies geographically and generally thought to be around 1-1.5% of all pregnancies 1,15. Clinical presentation Typic...
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Christmas inspired signs

There are many signs in radiology that are related to Christmas: snowcap sign in avascular necrosis snowman sign in total anomalous pulmonary venous return in pituitary macroadenomas snowstorm appearance in complete hydatidiform and testicular microlithiasis holly leaf sign in calcified pl...
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Cystic retroperitoneal lesions

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 perianal muc...
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Differential diagnosis of free fluid in cul de sac (pouch of Douglas)

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...
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Endometrial fluid

Fluid in the endometrial cavity can result from a number of causes if excessive and associated with distension.  Pathology There are essentially three types of fluid:  hydrometra: simple fluid haematometra: haemorrhagic content / clot pyometra: pus Premenopausal normal (i.e. physiological...
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Endometrial microcalcifications

Endometrial microcalcifications can arise from a vast range pathologies but are usually of benign in aetiology. Epidemiology They have an increased incidence with older age, postmenopausal state, atrophic endometrium, and endometrial polyps.  Radiographic features Ultrasound They are typica...
Article

Epithelial ovarian tumours

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. Epidemiology There is a difference in frequency of ovarian tumour subtypes depending on menop...
Article

Female infertility

Female infertility is common, and can be due to a number of factors. Radiology often plays a key part of the work-up.  Pathology Aetiology 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 immu...
Article

Frontal bossing

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. Pathology This feature can be seen in many conditions (in alphabetical order): 18q syndrome acromegaly achondroplasia ß-tha...
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Gonadal dysgenesis

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. Pathology In many cases the gonads are replaced by fibrous tissue. Subtypes complete gonadal dysgenesis (CGD) / Swyer syndro...
Article

Gynaecological ultrasound set-pieces

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. Structured approach uterus: size, version and shape (normal or variant which you should elaborate on and say w...
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Infertility

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: fema...
Article

Infertility in the exam

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...
Article

Intra-uterine contraceptive device

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 preventing implantation There are two main types of IUCDs: non-hormonal metallic...
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IUCD related uterine perforation

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.  Epidemiology The incidence rate is reported at ~2 in 1000 2. Clinical presentation Perforation at the time of insertio...
Article

Large for dates uterus

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.    Causes include : incorrect dates constitutionally large fetus multiple pregnancy fetal macrosomia polyhydramnios u...
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Malignant neoplasms involving the uterus

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...
Article

Metastases to the ovary

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.   Clinical presentation There...
Article

Myometrial cysts

Myometrium cysts are cysts seen in the myometrium and these can be differentiated appropriately based on location and sonological or Doppler features. Pathology Causes adenomyosis: the cysts are most often seen in the endomyometrial junction region. They ideally are small < 5mm, however may b...
Article

Narrow fetal thorax

A narrow fetal thorax on antenatal ultrasound can be present with a number of anomalies which include: achondrogenesis camptomelic dysplasia homozygous achondroplasia Jarcho-Levin syndrome Jeune syndrome - asphyxiating thoracic dysplasia Russell-Silver dwarfism short rib polydactyly syndr...
Article

Ovarian cystic neoplasms

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 50 is thought to be low 3-4. benign ovarian mature cystic teratoma cystadenomas ser...
Article

Ovarian lesions with T2 hypointensity

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: endometrioma Brenner tumour ovarian fibroma ovarian fibrothecoma ovarian cystadenofibro...
Article

Ovarian tumours

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. Pathology Subtypes Primary ovarian tumours Surface epithelial stromal ovarian tumours (60...
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Ovarian tumours associated with endometrial thickening

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...
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Pelvic masses in females

Pelvic masses in females carry a broad differential diagnosis: benign adnexal cyst: 34% leiomyoma: 14% pelvic malignancy: 14% dermoid: 13% endometriosis: 10% pelvic inflammatory disease: 8% tubo-ovarian abscess hydrosalpinx pregnancy Extra-gynaecological masses, e.g. colorectal carcino...
Article

Pelvic pain in the exam

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...
Article

Per vaginal bleeding in the exam

It is important to have a systematic way of approaching a case with per vaginal bleeding in the exam.  Premenopausal embedded IUD lost IUD submucosal fibroid Pregnancy related perigestational haemorrhage intrauterine fetal demise ectopic pregnancy ruptured ectopic cervical ectopic  in...
Article

Perigestational haemorrhage

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...
Article

Phocomelia

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. Path...
Article

Placentomegaly

Placentomegaly is a term applied to an abnormally enlarged placenta.  Pathology Associations It can be associated with number of maternal and fetal disorders which include: maternal maternal anaemia(s) maternal diabetes chronic intrauterine infections alpha-thalassemia fetal umbilical ...
Article

Polyhydramnios

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 ...
Article

Primary peritoneal neoplasms

Primary peritoneal neoplasms comprise of an uncommon group of heterogenous entities. The list includes mesothelial derivatives primary (malignant) peritoneal mesothelioma primary perioneal multicystic mesothelioma primary peritoneal well differentiated papillary mesothelioma primary perito...
Article

Pyometrium

A pyometrium refers to infection of the endometrial cavity with resulting expansion due to accumulated pus. Pathology Causes endometritis / pelvic inflammatory disease uterine malignacies pelvic irradiation cervical stenosis retained products of conception imperforate hymen colo-uterin...
Article

Rhizomelic dwarfism

Rhizomelic dwarfism is a type of dwarfism where the dominant feature is proximal (i.e. femoral, humeral) limb shortening. Pathology The following conditions fall under the heading of rhizomelic dwarfism 3 metatropic dysplasia achondrogenesis rhizomelic chondrodysplasia punctata achondropla...
Article

Right iliac fossa mass (differential)

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. Differential diagnosis appendicular mass appendicular abscess appendicular mucocele appendicular neoplasms ileocaec...
Article

Short umbilical cord

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.  Pathology Associations Recognised associations include chromosomal anomalie...
Article

Shortened fetal femoral length

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...
Article

Sister Mary Joseph nodule

A Sister Mary Joseph nodule is a metastatic lesion involving the umbilicus. The most common primary source is an intra-abdominal adenocarcinoma. Epidemiology Umbilical metastases are uncommon, reportedly present in 1-3% of all intra-abdominal and/or pelvic malignancy 7. Clinical presentation ...
Article

Sonographic values in obstetrics and gynaecology

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. 1 mm rate of increase of a mean sac diameter per day in early pregnancy 2 mm generally accepted value for a th...
Article

Syndactyly

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). Epidemiology The overall estimated incidence is at ~1 per 2500 to 5000 live births 6,8. The...
Article

Uterine enlargement (differential)

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 hormonal causes exogenous h...
Article

Vulval neoplasms

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. Pathology Squamous neoplastic lesions  Premalignant  classic vulvar intraepithelial neopla...

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