Chapter 19 Pelvic anatomy

Which congenital uterine anomaly does not distort the normal contour of the fondus?

A septae Septae uterus displays a normal uterine contour with a fibrous or myometrial separation in the endometrial cavity. Bicorunate, unicorunate and didelphys are congenital uterine anomalies demonstrating an abnormal contour to the fundus

Which uterine anomaly most likely demonstrates a small dimple in th efundus

A subsepte the subseptae uterus is most likely to display a shallow fundal notch. a bicorunate uterus generally displays a deep fundamental notch

Partial fusion of the caudal mullein ducts will m most likely result in an anomaly of the

A uterus The uterus is derived from the fused

In the sagittal sonogram the uterus is lying in which of the following positions?

A. anteversion The uterus bends slightly anterior (forward), characteristic of ante version with ante flexion, the uterus bends on the cervix. Dextroflexion displaces the uterus to the left of the cervix

The position of the uterus is

A. anteverted The uterus is lying in the anteverted position. in retroflexion, the fondus and body curve backward on the cervix

Ovarian volume is lower during the

A. luteal phase Ovarian volume is lowest during the luteal phase and highest during preovulatory phase

Prominent anechoic structures near the periphery of the uterus most likely represent?

Arcuate vessels Arcuate vessels are commonly visualized near the periphery of the uterus as an anechoic circular structures Nabothian cysts are located in the cervix

The region including the ovary and the Fallopian tube is termed the:

B adnexa Adnexa is the term used to describe the region of the ovary and Fallopian tube. Space of retries is located anterior to the urinary bladder and posterior to the symphysis pubis the one fimbriae attached to the ovary is termed the fimbriae ovarica

Which uterine position displays the fundus of the uterus anterior to the cervix

B anteflexion with ante flexion the fondus of the uterus bends on top of the cervix. The uterus bends behind the cervix in retroflexion

When measuring endometrial thickness, calipers are placed from

B echogenic interface to echogenic interface Only the functional layer (echogenic) is included when measuring endometrial thickness. the hypoechoic basal layer or fluid within the endometrial cavity is not included when measuring the thickness of the endometrium.

a patient complains of right flank and right lower quadrant pain. based on this clinical history the sonogram most likely demonstrates

B hydrometer An anechoic tubular structure terminates in the posterior lateral wall of the urinary bladder. this is most consistent with a hydroureter

Visualization of pelvic ligaments appears on sonography as

B hyperechoic linear structures Pelvic ligaments are not routinely visualized. With the presence of intraperitoneal fluid pelvic ligaments appear as thin hyperechoic linear structures

which of the following structures is not lined by the peritoneum

B ovary

The uterosacral ligament extends from the lateral margins of the sacrum to the

B superior cervix

Secondary blood supply to the ovaries is through the

B uterine arteries the ovaries receive blood primarily from the ovarian arteries and secondarily through th euterine arteries. the uterine arteries arise from the hypogastric arteries

The vesicouterine pouch is located

B. anterior to the uterus and posterior to the urinary bladder The vesicouterine pouch anterior cul de sac is located anterior to the uterus and posterior to the urinary bladder. the retrouterine space posterior cul de sac is located posterior to the uterus and anterior to the rectum

A patient presents with a history of chronic cirrhosis and abdominal distention. the hyper echoic linear structures lateral to the uterus most likely represent the

B. broad ligament The hyperechoic linear structure extends from the uterus to the pelvic sidewall. this is most consistent with the broad ligaments the fallopian tubes are tortuous and do not attach to the pelvic sidewall

Congenital uterine anomalies are associated with coexisting anomalies of the

B. kidneys Coexisting renal anomalies occur in 20% to 30% of patients with a congenital uterine anomaly

Which of the pelvic muscles are the arrows identifying

B. levator ani The levator ani and pirifonmis muscles form the pelvic floor and lie posterior to the vagina. Obturator internus and iliopsoas muscles are located in the lateral true pelvis.

Which of the following attaches to the ovary

B.broad ligament The ovaries attach to the mesovarian portion of the broad ligament. the tunica albuginea is an outer covering of the ovary

Which of the following correctly measures endometrial thickness

C anterior posterior dimension in the sagittal plane The anterior posterior dimension of the endometrium is only measured in the sagittal plane.

The pelvis is divided into the true and false pelvis by the

C iliopectineal line

Which segment of the Fallopian tube connects with the uterus?

C interstitial Interstitial segment of the fallopian tube passes through the cornula of the uterus. the infundibulum is the most lateral segment of the oviduct

A perimenopausal patient presents with a history of pelvic fullness and pain. a sagittal sonogram displays fluid collection in the

C pouch of Douglas Fluid is demonstrated posterior to the uterus in the pouch of Douglas. The vesicouterine pouch is located anterior to the uterus

The corn of the uterus is located between the

C uterine fondus and Fallopian tube The coruna are the lateral funnel shaped horns of the uterus located between the uterine fondus and fallopian tube

in the menarche patient, the endometrial thickness should not exceed

C. 14mm

A 30 year old patient presents with a history of dysmenorrhea the arrows in the sonogram are most likely identifying

C. arcuate vessels Evenly spaced, hypoechoic or anechoic, circular structures identified in the outer in the outer portion of the myometrium most likely represent arcuate veins uterine arteries are located in the broad ligament lateral to the uterus

The spiral artery provides the primary blood supply to which of the following pelvic structures

C. endometrium The spiral artery arises from the radial arteries (a branch of the arcuate artery) and is the primary blood supply to the endometrium.

The innermost layer of the myometrium is termed the

C. junctional zone

Which of the following is a surface region located below the pelvic floor

C. perineum Situated between the symphysis pubis and coccyx the perineum is located below the pelvic floor. The mesentery, momentum, and peritoneum are located within the abdominopelvic cavity.

The secretion of time previous to the onset of menstration is termed

C. premenarche premenarche is the portion of time before the onset of menstruation puberty is the physical process of changing into an adult body capable of reproduction

It is common to visualize a small amount of free fluid in the:

C. retrouterine space It is common to visualize a small amount of free fluid in the retrouterine space posterior culled sac

Which of the following most accurately describes the perimetric

C. the serial surface of the uterus is termed the perimetrium The external or serosal layer of the uterus is termed the perimetrium

in premenarche, the size of the uterine cervix is expected to be

C. twice as large as the corpus The cervix is twice as large as the corpus during premenarche. The cervix to corpus ratio is 2:1

identification of free fluid in the pelvis is located in the

C. vesicouterine and retrouterine spaces Free fluid is identified anterior and posterior to the uterus in the vesicouterine and retrouterine spaces. The small anechoic area represents a small amount of urine in an other wise empty bladder.

the pelvic floor is formed by the pelvic

D ligaments and muscles

ovarian volume is the highest during the

D preovulatory phase

The ovary is attached to the pelvic sidewall by the

D suspensory ligament The suspensory ligaments extend from the lateral aspect of the ovary to the pelvic sidewalls. the broad ligaments extend from the lateral aspect of the uterus to the pelvic sidewalls

Which pelvic ligament extends rom the cornua of the uterus to the medial aspect of the ovary?

D. Ovarian the ovarian ligament extends from the corona of the uterus to the medial aspect of the ovary. the round ligament arises in the corona of the uterus and extends tot he pelvic sidewalls.

the ovary is likely demonstrating a

D. anatomical variant An L shaped homogeneous ovarian contour is a normal anatomical variant.

A patient presents with a heavy history of multiple miscarriages. her last menstrual period was 3 weeks earlier. on the basis of this clinical history, the sonogram is most suspicious for a.

D. bicorunate uterus The uterus displays myometrial tissue between two individual endometrial cavities. this is most consistent with bicorunate uterus

The coronal sonogram most likely identifes

D. bicorunate uterus Two distinct endometrial cavities are identified with myometrial tissue between the cavities and a single uterine cervix consistent with a bicorunate uterus. uterine didelphys demonstrates two individual endometrial cavities and cervixes.

An anechoic mass contiguous wit the posterior wall of the urinary bladder is most consistent with a

D. bladder diverticulum An anechoic pedunculation of the urinary bladder describes a diverticulum. A uterocele is a prolapse of the distal ureter into the bladder

The Fallopian tube divides into which of the following segments

D. interstitial isthmus ampulla infindibulum The segments of the Fallopian tube include the interstitial isthmus, ampulla, and infundibulum

The hypo echoic structure identified by the arrow most likely represents the

D. obturator internees muscle The obturator internus muscles about the lateral walls of the urinary bladder. Iliopsoas muscles demonstrate a classic hyperechoic central echo Levator ani muscles lie lateral to the Vagina

Which of the following muscles abuts the lateral walls of the urinary bladder?

D. obturator internus The obturator interns muscles abut the lateral walls of th eurinary bladder. the iliopsoas muscles are lateral landmarks of the true pelvis lying lateral and anterior to the obturator internus muscles

The flanged portions of th iliac bones form the

D. posterior border of the false pelvis The flanged portions of the iliac bones and the base of the sacrum form the posterior boundary of the false pelvis

This saggital image of the uterus most likely represents a

D. postmenopusal uterus The cervix and corpus appear equal to in size 1:1. This is most consistent with a postmenopausal uterus. The cervix is twice the size of the corpus in a premenarche patient 2:1

The position of the uterus in this sagittal sonogram is termed

D. retroversion The uterus displays a posterior tilt and the cervix forms an angle less than 90 to the vaginal canal characteristic of retroversion

Failure of the mullein ducts to fuse will most likely result in

D. uterine didelpys Failure of the mullein ducts to fuse will result in uterine didelphys. Partial failure of these ducts to fuse will result in a bicorunate uterus. failure of the mullein ducts to develop results in uterine agenesis.