Normal Anatomy of the Female Pelvis

Bowels produce:

"dirty shadows"

the ovary may be identified by this characteristic:

"swiss cheese"---pattern of anechoic follicles

Endometrium thickness postmenstrual, cycle days 6-9

2-4 mm mostely anechoic

A mature follicle reaches _____ in size before rupturing

20 mm

How many oz of water does a hydrated patient need to drink to fill the urinary bladder?

32 oz

Endometrium thickness during proliferative phase, cycle days 10-13

5-8 mm, slightly echogenic

Endometrium thickness during secretory phase, cycle days 14-28

9-14 mm, highly echogenic

Endometrium thickness during menses, cycle day 1-5.

<1 mm thin echogenic line

To optain standard pelvic sonogram guidelines for sonographers, contact the website for"

American Institute of Ultrasound in Medicine (AIUM) or American College of Radiology (ACR)

Uterine position with the bending of the fundus towared the abdominal wall

Anteflexion

The potential spacebetween the uterus and urinary bladder

Anterior cul-de-sac

Tipping of the uterus toward the anterior wall. This is the usual position of the uterus with an empty bladder.

Anteverted

Branches of the uterine artery

Arcuate, vaginal

Tissue that replaces the corpus luteum

Corpora albicantia

What increases image detail during the endovaginal exam?

Decreased depth

uterus flexed to the right

Dextroflexed

Uterus displacement to the right

Dextroposition

Variant that has the uterus displaced to the right

Dextroposition

Gassy bowel can be _____ away form the field of view by filling the urinary bladder, which provides a _____ window into pelvic structures

Displaced, acoustic

Branches of the aorta that supplies the pelvic organs

External and internal iliac

The ripening follicle is referred to as

Graafian follicle

Uterus flexed to the left

Levoflexed

Uterus displaced to the left

Levopostion

Which ligament anchors the posterior surface of the ovary?

Mesovarium

Midcycle pain often associated with ovulaton:

Mittelschmerz

Cysts of the cervix are caused by occluded cervical glands, and known as:

Nabothian cysts

Which organ is completely inside the peritoneal sac?

Ovary

The ______ muscle is often obscured by bowel gas, but is most likely seen with a very full urinary bladder.

Piriformis

A transverse pelvic ultrasound demonstrates two abdominal and pelvic muscles:

Psoas, ructus abdominis

Backward displacement of the entire uterus

Retrocession

Bending of the fundus toward the rectum

Retroflexed

Comination of retroversion and retroflexion

Retroversioflexion

Tipping of the entire uterus toward the sacrum

Retroverted

The sigmoid typically forms one or more:

S curves

Artifact that happens when stuff from side lobes gets registered like it came from the main beam.

Side lobe artifact

Internal iliac artery branches that supply the pelvic organs:

Uterine, ovarian, bladder, rectum, ubilical artery in the fetus

Uterine and ovary size varies due to:

age,menstrual cycle, and hormone status

Aorta supplies:

all pelvic organs via branches

Internal iliac artery (aka hypogastric artery) supplies:

all pelvic organs via branches

The longest fallopian tube region, is quite tortuous in vivo. Terminates in the trumpet shaped infundibulum

ampullary portion

A uterus lying in a plane perpindicular to the ultrasound beam entering through a full bladder is labeled as:

anteflexed

Vesicouterine recess. Potential space between the uterus and the urinary bladder

anterior cul-de-sac

The bladder has 3 portions:

apex, base, neck

The space of Retzius (peritoneal space) is located:

between the urinary bladder and the symphysis pubis

What is the largest portion of the uterus?

body; corpus

Which ligament attaches the cervix to the sacrum?

cardinal ligaments

Visualization of the coronal plane in 3D imaging enables the uterine ____,____, and ____ to be viewed for an accurate diagnosis.

cavity, myometrium, fundus

Cylindrical neck of the uterus that projects into the vagina

cervix

Inferior portion of the uterus

cervix

The upper end of the vagina attaches to the ____

cervix

Hair-like structures that flex in synchronized waves force the surface mucus toward the surface

cilia

Four fused bodies from the

coccyx

What bones comprise the pelvic skeleton?

coccyx, sacrum, and the two innominate bones

On the opposite side

contralateral

Fibrous tissue that replaces the corpus luteum

corpora albicantia

Cystic structure that sometimes occurs throughout the first trimester of pregnancy:

corpus luteum cyst of pregnancy

A uterus in a young girl would appear:

cylindrical

What is not a benefit of endovaginal ultrasound?

depth of penetration

Fat or smooth muscles are more ______ than the skeletal muscles.

echogenic

Specialized mucosa that varies in echogenicity, thickness, and composition thorugh the menstrual cycle

endometrium

The ultrasound imaging method of choice for ovarian assessement is:

endovaginal

The technique offering the most direct assessment of the pelvic anatomy:

endovaginal EVS

Greater or major pelvis. Area superior to and anterior to the pelvic brim

false pelvis

Hormone that stimulates growth and maturation of the ovarian Graafian follicle. The anterior pituitary gland secretes the hormone.

follicle-stimulating hormone (FSH)

Degeneration and reabsorption of the follicle before maturity

follicular atresia

Iliac crest

found on the top of the hip bone.

Latin anatomical term referring to the portion of an organ opposite from its opening.

fundus

Outer layer of the ovary

germinal epithelium (which is not actually germinal nor a true epithelium)

The early developing follicle is a solid mass consisting of

granulosa cells surrounding the central ovum

Multiparous adult:

has given birth two or more times

Increase in size

hypertrophy

Pelvic brim or linea terminalis. Inner surface of the pubic and ilium bones contains a bony ridge that serves as the line dividing the true and false pelvis

iliopectinal line

Combination of the psoas major, psoas minor, and iliacus muscles

iliospoas muscle

Consists of fibromuscular strands intertwined with the ovarian vessels and lympahtics as the pass from the brim of the pelvis to the lateral pole of the ovary. Forma ridge in the overlying peritoneum, which is thicker in this region and contributes to the suspensory effect

infundibulopelvic ligament

Fallopian tube portion that is fringed with finger-like projections, called fimbriae

infundibulum

During an EV ultrasound, slight residual urine in the bladder will help identify the:

internal os of the cervix

Region of the fallopian tube that is relatively straight, and located within the uterine wall

intramural (interstitial)

The fallopian tube is divided into three sections, called:

intramural, isthmic, ampullary

On the same side

ipsilateral

Ovaries of infants and postmenopausal women become difficult to detect, as they are:

isochoic with the surrounding tissues

Region of the fallopian tube that is longer and slightly wavy in its course

isthmic portion

What makes up the external genitalia?

labia majora, labia minora

Uterine vessels, broad ligaments, fallopian tubes, and ovaries are all:

lateral to the uterus

An imaginary line between the true and false pelvis is:

linea terminalis

Innominate line. Line drawn from the pubic crest to the arcuate line dividing the true and false pelvis

linea terminalis

The posterior wall of the vagina is ____, than the anterior wall

longer

Echogenic ovarian foci, with or without shadowing, noted on an ovary may indicate presence of:

malignancies

A short double layer of peritoneum extending from the posterior surface of the broad ligament, providing a minimal suspensory effect, and provides the primary route of access for vessels entering the ovarian hilum.

mesovarium

The muscular middle layer of the uterus, that forms most of the bulk of the uterine body:

myometrium

Nulliparous adult:

never given birth

Ipsilateral anatomy

on the same side

At right angles (perpendicular)

orthogonal

Subdivisions of the myometrium:

outer layer (longitudinal muscle fibers), a richly vascularized thick middle layer, and a dense inner layer of which predominantly spiral muscle fibers are arranged both longitudinally and obliquely.

Flattened fibromuscular band, extends from the uterine cornu, where the fallopian tube exits the uterine wall, to the inferior pole of the ovary

ovarian ligament

Bulk of the ovarian substance consists of a thick layer of

ovarian parenchyma, the cortex, which contains a large number of primordial follicles

Ovarian (gonadal) artery supplies:

ovary, ureters, fallopian tubes

Obturator internus muscle

paired pelvic muscles located lateral to the ovaries

Bowel can mimic a:

pelvic mass

External genitalia, urinary bladder, urethra, uterus, fallopian, tubes, vagina, ovaries, colon, and rectum are classified as

pelvic organs

Bowel is most likely going to appear like a mass without the presence of:

peristalsis

Posterior cul-de-sac or the rectouterine recess. Potential space between the rectum and the uterus

pouch of douglas

Contraindiction of TVS includes _______ and _________

premature rupture of membranes, prepubertal virgins

Dropping of the uterus into the vaginal canal

prolape

The true pelvis contains organs of:

reproduction

Five fused vertebral bodies form the

sacrum

Serous membrane enclosing an organ that often excretes lubricating serous fluid

serosa

The uterine layers are:

serosal (perimetrium), continuous with fascia; myometrium, smooth muscle and connective tissue; endometrium, mucosal

The descending colon becomes the

sigmoid colon

Properitoneal space. Space between pubic symphysis and urinary bladder

space of Retzius

3 imaging techniques that may help diagnose ovarian torsion:

spectral, color,and power doppler

A ___________ that seals the uterus from bacteria during pregnancy is generated in the glands of the mucosa of the _____ canal.

sticky mucous plug, endovaginal

Compostion of the endometrium:

superficial layer, and a deep basal layer

Define linea terminalis:

the linedrawn from the pubic crest to the arcuate line dividing the true and false pelvis

Three anchoring structures suspending the ovary in the pelvic space:

the ovarian ligaement, the infundibulopelvic ligament, and the mesovarium.

The vagina is:

thin-walled, 7-10 cm long, and produces a moderately hypoechoic pattern

Where does the sigmoid colon enter the pelvic space?

through the left iliac fossa

the sonographic method that uses the lower frequency transducers?

transabdominal TAS

Lesser or minor pelvis. Portion of the pelvic cavity inferior and posterior to the pelvic rim

true pelvis

Immediately beneath the germinal epithelium is a thin layer of fibrous tissue, which forms the:

tunica albuginea (white coat, or capsule of the ovary)

One branch of the internal iliac artery is of importance to sonographers because it is accessible to Doppler evaluation using endovaginal approach. It is the:

uterine artery

The uterine artery supplies:

uterus, fallopian tube, ovary, vagina

In the case of venous congestion, veins may form a pelvic _______ which are readility identifiable by ultrasound

varices

Ovaries should be measured using a:

volume calculation: (length x width x height/2=volume in cm3)

It is not uncommon to see anterior echos in the urinary bladder, they are:

wall reverberations

Three functions of the female bony pelvis are:

weight bearing, directs the pathway, and protects