Chapter 42- Sonographic and Doppler Evaluation of the Female Pelvis
parity
(obstetrics) the number of live-born children a woman has delivered
transabdominal
A ______ is also necessary to evaluate a large adnexal mass and determine its origin
clinical history
A complete ______ is critical in order to tailor the ultrasound exam and correlate ultrasound findings with the proper differential consideration
history
A complete patient _____ is critical in order to tailor the ultrasound exam and correlate ultraound findings with the proper differential consideration
5 MHz
A transabdominal exam is performed from the anterior abdominal wall using a curvilinear or sector transducer with frequencies of up to ____
7.5 MHz
A transvaginal examination is performed with the patient's bladder empty using higher transducer frequencies of ____ or more
shortening
A transvaginal ultrasound gives a better visual survery by ______ the distance from the transducer to the ovaries, uterus, and adnexal regions
explanation
An adequate _______ of the transvaginal ultrasound is essential
hyperechoic, 2, 3
As menses progress (days 3-7), the hypoechoic echo that represents the blood in the endometrial canal disappears and the endometrial stripe becomes a thin, _____ line measuring about ___ -___ mm
menstruation, 4, 8, hyperechoic
During ______, the endometrial canal appears as a hypoechoic central line representing the blood and tissue and reaches ___ to ____ mm, including the basal layer. This is surrounded by a _____ basal endometrial canal
hypoechoic, 4, 8
During menstruation (day 1-4) the endometrial canal appears as a ______ central line representing blood and tissue and reaches ___ -___ mm, in measurement, including the basal layer
increases
During the late proliferative phase, the endometrium _____ in thickness and echogenecity
15, 28, posterior enhancement
During the secretory phase (days ___-____), the endometirum is at its greatest thickness and echogenecity with ________
isoechoic
During the secretory phase, the functionalis layer becomes ______ with the basal layer.
cervix
Flexion refers to the axis of the uterine body relative to the _____
acoustic window
For a transabdominal ultrasound, the distended urinary bladder is used as an ________
near-field
Higher frequencies that are used in transvaginal scanning have better ______ focusing and resolution, permitting greater detail and characterization of the uterus and adnexa
size, shape, location, echo graphic, uterus, ovaries
If a mass is detected in the cul-de-sac, it is important to document ____, _____, _____, and _____ pattern, as well as its relationship to the ____ and ____
right upper quadrant
If pathology is present, documentation the _____ (Morison's pouch, subphrenic area, and bilateral renal areas) must be obtained to demonstrate the presence or absence of free fluid
free fluid, mass
In a pelvic scan, it is important to evaluate the cul-de-sac for presence of _____ or a ____
cul-de-sac, size, position, echogenic, ovaries, uterus, turning on it
In a pelvic ultrasound, it is necessary to evaluate the ______ for free fluid or mass if mass is detected, document ____, _____, shape, _____ pattern, relationship to _____ and _____ Be sure to differentiate normal loops of bowel from a mass by _______
acoustic window
In a transabdominal ultrasound, the distended bladder serves as an _______
3.5, 5
In most average patients, the transabdominal survey is performed with a transducer frequency range of ____ to ___ MHz
turn on it
In the cul-de-sac, it is important to differentiate normal loops of bowel from a mass. How do we do this?
no
Is fluid found within the endometrial canal included in the measurement?
size, shape, contour, echogenecity, uterus
It is important to document the ____, _____, _____ and _____ of the ovaries, as well as their position relative to the ______
size, shape, orientation
It is important when scanning the uterus to notate _____, ______, and ______
lmp, menstrual, hormone, cancer, cancer
It is useful for the sonographer to use a routine patient questionaire requesting information such as: 1. date of _____ 2. gravidity and parity 3. ______ status 4. ______ regimen 5. symptoms 6. history of ______ 7. family history of _______ 8. past pelvic surgeries 9. lab tests 10. biopsy results 11. pelvic exam finding
menstrual period, parity, menstrual, hormone, cancer, cancer, surgeries
It is useful for the sonographer to use a routine patient questionaire requesting information such as: 1. date of last _____ 2. gravidity and ______ 3. ______ status 4. ______ regimen 5. symptoms 6. history of ______ 7. family history of _____ 8. past pelvic ______ 9. lab tests 10. biopsy results 11. pelvic exam findings
fluid, fluid
Normal fallopian tubes can be difficult to identify by transabdominal or transvaginal sonography unless surrounded by _____or filled with _____
anterior
Ovaries should be identified _____ to the internal iliac vessels
muscles
Pelvic _____ may be mistaken for ovaries, fluid collections, or masses.
Doppler
Pelvic vascularity can be evaluated using real-time _____ imaging
Doppler
Pelvic vascularity can easily be evaluated by using real time and ______ imaging
right upper
Residual fluid in the bladder is a helpful orientation landmark and should always appear in the _____ ______ corner of the screen in the sagittal plane when performing a transabdominal ultrasoubd
right upper corner
Residual fluid in the bladder is a helpful orientation landmark and should always appear in the ________ of the screen in the sagittal plane during a transvaginal scan
echogenic
Sonographic appearance of the endometrial canal is seen as a thin ______ line
follicular cysts
Sonographically, the ovary appears as an ovoid medium level echogenic structure. _______ may be seen peripherally in the cortex.
radial arteries
The _____ arise as multiple branches from the arcuate arteries and travel centrally to supply the rich capillary network in the deeper layers of the myometrium and endometrium
iliac vessels
The _____ can be used as a landmark to identify the lateral adnexal borders
secretory
The _____ endometrium is at its greatest thickness and echogenecity with posterior acoustic enhancement
cervix
The _____ is fixed in midline, but the uterine body is mobile and may lie obliquely on either side of midline
endometrium
The _____ is thin, compact, and relatively hypovascular.
vagina
The _____ serves as a landmark for the cervix and lower uterine segment
transabdominal
The _____ ultrasound visualized the entire pelvis and gives a global overview
transabdominally
The ______ approach is especially important when the ovary is in an obscure location so as to determine a general location to interrogate endovaginally
transabdominal
The _______ approach visualizes the entire pelvis and gives a global overview
uterine artery, internal iliac vessel
The anterior vagina and cervix is supplied with blood from a branch off the _______ before it reaches the uterus. The posterior surface of the vagina is supplied with blood from a branch off the _________
anterior
The arteries may be noted ______ to the veins in the pelvis
fundus
The bladder is considered optimally full when it covers the _____ of the normal-sized uterus
fundus
The bladder is considered optimally full when it covers the ______ of the normal-sized uterus
menstrual cycle
The blood flow of the functional ovary varies with _______
isthmus, internal os
The body of the uterus is separated from the cervix by the ______ at the level of the ______
5, 9, hypoechoic, basalis, three-line sign
The early proliferative phase is from days ___ -____, and during this, the endometrial canal appears as a single thing stripe. The functionalis layer is seen as a ____ halo encompassing this, and the thic echogenic layer surrounding the functionalis layer is the _____ layer. This complex creates the _______.
reflection
The echogenicity of the endometrial canal is the result of specular ______ from the interface between opposing surfaces of endometrium.
7, 14
The endometrial complex usually measures ___ - ____ mm during the secretory phase
basalis
The endometrial thickness is measured from the highly reflective interface of the ____ layer and the myometrium
functional, basal
The endometrium comsists of two layers:
functionalis, basal
The endometrium consists of 2 layers:
thickness, echogenecity
The endometrium is analyzed for _____ and ____
flatten
The full bladder serves as an acoustic window, as well as to _____ the anteflexed uterus slightly so it is more perpendicular to the transducer angle
endometrium, hypoechoic
The inner layer of the uterus is the ______. It is _____ and surrounds the relatively echogenic endometrial stripe, creating a subendometrial halo
endometrium, hypoechoic, echogenic
The inner layer of the uterus is the _______. It is thin, compact, and relatively hypo vascular. It is _____ and surrounds a relatively _______ endometrial stripe, creating a subendometrial halo.
myometrium, homogeneous
The middle layer of the uterus is the _____. It should appear ______ with smooth-walled borders. Any area of increased or decreased echotexture should be noted.
myometrium, homogeneous
The middle layer of the uterus is the ______ and it should have a ______ echotexture with smooth-walled borders
arcuate
The normal _____ vessels are often seen in the periphery of the uterus and should not be mistaken for pathology
arcuate vessels
The normal ______ are often seen in the periphery of the uterus and should not be mistaken for pathology.
aorta
The ovary receives its blood supply from the ______.
premenarche, menarche, menopause
The patient's menstrual status is described by using the terms ____, ____, and _____
clinical history, indication
The role of the sonographer is to gather the ______, identify the referring physician's _____ for study, review previous imaging results, and tailor the ultrasound exam to each patient
history
The role of the sonographer is to gather the clinical _____, identify the referring physician's indication for the study, review the previous imaging results, and tailor the ultrasound exam to each patient
echogenic
The sonographic appearance of the endometrial canal is seen as a thin _____ line as a result of specular reflections from the interface between opposing surfaces of the endometrium
transabdominally
The sonographic approach ot evaluating the ovary is initially performed _______
because of their distance from the transducer and interference from bowel
The transabdominal technique gives a less than optimal view of the adnexal regions. Why?
serosa
The uterine muscle consists of three layers, and the outer ____ of the uterus is not visualized sonographically
serosa
The uterine muscles consist of three layers, and the outer ______ is not usually visualized sonographically
anteflexed
The uterus is usually anteverted and ______
two
The vagina has ____ sources of blood
homogeneous
Tissue echogenecity surrounding the cervical canal should appear ______
homogeneous
Tissue echogenecity surrounding the cervical canal should appear _______
lateral, internal os
To assess the uterine vessels, the sonographer interrogates just _____ to the cervix and lower uterine segment at the level of the _____
cervix, internal os
To assess the uterine vessels, the sonographer interrogates just lateral to the _______ and lower uterine segment at the level of the _________
gravidity
Total number of pregnancies
true
Transabdominal and transvaginal sonography are complementary techniques. True or false?
urinary bladder
Transabdominal scans usually use a distended ______ as a sonic window to identify the uterus and adnexa as an overview of the other pelvic structures
anteromedial
Typically, the ovary is located just lateral to the uterus and ______ to the internal iliac vessels, which can be used as a landmark to localize the ovary.
fundus, cervix
Uterine length is measured in the long axis from the _____ to the _____
vagina
Version refers to the axis of the uterine body relative to the ______
obturator internus, pelvic floor, iliopsoas
What are the three groups of muscles that form the pelvis?
levator ani, piriformis, coccygeus
What muscles form the pelvic floor? (3)
location, size, external contour, internal consistency
When a mass is found in sonography, the following features should be characterized: ______ (uterine or extrauterine) ______ ______ (well, defined, ill-defined, or irregular borders) _______ (cystic, complex, or solid)
well-defined, ill-defined, irregular borders
When asked to describe the external contour of something, use the words:
solid, cystic, complex
When asked to describe the internal consistency of a mass, use the words:
well-defined, ill-defined, irregular
When describing external contour, what words do you use?
cystic, complex, solid
When describing internal consistency, what words do you use?
vagina, uterus
When performing an ultrasound of the uterus, the ____ and _____ serve as anatomic landmarks
transabdominal, endovaginal
______ and ______ sonography are complementary techniques, and both are used for a complete evaluation of the female pelvis
critical thinking
______ by the sonographer produces valid, reliable, and reproducible results that are the basis for an effective diagnostic medical sonographic practice.
posterior enhancement
______ during the secretory phase is thought to be attributed to the increased vascularity of the endometrium
overdistension
______ of the bladder may compromise the sonographic evaluation and compress, distort, and displace anatomy
critical thinking
________ by the sonographer produces valid, reliable, and reproducible results that are the basis of an effective diagnostic medical sonographic practice.
obturator internus
muscle of the true pelvis that lies in the lateral boundary of the pelvis, one on each side, seen on u.s lateral to the bladder, and inserts into the greater trochanter
levator ani
one of two muscles of the pelvic diaphragm that stretch across the floor of the pelvic cavity like a hammock, supporting the pelvic organs and surrounding the urethra, vagina, and rectum; a broad thin muscle that consists of the pubococcygeus, iliococcygeus, and puborectalis
arcuate vessels
small vessels found along the periphery of the uterus
