Ultrasound | Uterus

Ashley Davidoff MD

Introduction

The Corpus

Normal Gray Scale and Power Doppler

46314c01 uterus endometrium blood flow myometrium perfusion normal anatomy USscan Davidoff MD

Cervix

Nabothian Cysts

Sagittal View of the Cervix

The ultrasound is from a 40 year old patient who presents with pelvic discomfort . Nabothian cysts in the cervix are of incidental note. They are cystic in nature demonstaring anechogenicity, through transmission, and backwall enhancement. The examination was otherwise normal.

The Endometrial Cavity

Thin Stripe

Post Menopausal Atrophy

The transvaginal ultrasound is from a 62 year old post menopausal patient who presents with pelvic discomfort. The ultrasound shows a small atrophied uterus. The myometrium (dark red) junctional zone (light red) and endometrial cavity (pink) are outlined. In the sagittal plane the uterus measures 3.4cms in cranoicaudal dimension by 2.4cms in anteroposterior dimension (a,b) In the axial dimension (c,d) the uterus measures 2.4cms. The endometrial stripe is measured in the sagittal plane and measures .7mms.

Turners Syndrome

Small uterus Small Stripe

The ultrasound is from a patient with Turners syndromerevealing an exteremely small uterus measuring 4.6X 1×1.6cms. The endometrial stripe measures about 1mms uterus Turner’s syndrome size congenital small USscan ultrasound

Thick Stripe

Hyperplasia

The transvaginal ultrasound is from a 60 year old female who presents with spotting Ultrasound reveals a heterogeneous endometrial stripe consistent with endometrial hyperplasia though endometrial carcinoma is a possibility. Malignant neoplasia is a a les likely possibility

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Endometrial Carcinoma and Uterine Obstruction

Use of Doppler

The ultrasound is from a 70 year old post menopausal female who presents with an enlarged uterus. The endometrial stripe is enlarged and is filled with fluid and an enhancing soft tissue mass consistent with an endometrial carcinoma. Note blood flow as depicted by Doppler exam (c) characterizing the soft tissue as tumor rather than a clot.

Obstruction

Cervical Stenosis

Cervical Stenosis and Metrorrhagia

The transvaginal ultrasound is from a 50 year old perimenopausal female with metrorhagia. The uterine cavity and cervical cavity are filled with fluid, and soft tissue elements are identified in the expanded cervical canal. The findings are consistent with cervical stenosis, burt the cause of the metrirhagia is not obvious. The stenosis was relieved and follow up ultrasound showed resolution. No cervical mass was identified.

Polyp

Polyp as a Cause of Obstruction

Presumed Benign Disease

The ultrasound and MRIscan are from a 67 year old female, with an LMP of 10 years ago and with gynecologic history G9 and current history of bleeding for one month, a fever and low hematocrit. She has not had follow up gynecological examination for many years. The studies reveal a mass in the lower uterine segment and an obstructed endometrial cavity tha contains complex material which is presumed combination of blood and pus. ie hematometria and pyometria. The ultrasound is far more impressive than the MRI in that the mass (green) looks more impressive in size and there is prominent upstream accumulation of of complex material and fluids. The MRI shows a enhancing lesion arising from the endometrial mucosa, and at this time the fundal portion is relatively decompressed. The mass is presumably a benign polyp since her subsequent history to the hospital revealed only follow up for chronic renal failure and no pathological report of a malignancy has been n noted.