Ed's GYN 7 Lecture
What is the clinical presentation of Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)).
Abnormal vagina bleeding
What is the clinical presentation of Retained Products of Conception (RPOC)?
Abnormal, excessive, sustained postpartum vaginal bleeding
What are some differential diagnoses of ovarian/adnexal torsion?
Appendicitis, hemorrhagic cyst
What C-section complication is due to bleeding in the LUS or in between the LUS and bladder?
Bladder flap hematoma
What are some complications of Retained Products of Conception (RPOC)?
Bleeding, infection
What are some causes and risk factors of Pelvic congestion syndrome?
Incompetent ovarian vein, incompetency of internal iliac vein, nutcracker syndrome, May-Thurner syndrome, pregnancy
Where is the thrombus usually found in Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?
Junction of the right renal vein with the IVC
What is the treatment for ovarian/adnexal torsion?
Laparoscopic detorsion
Describe the sonographic appearance of a subfascial hematoma
Large heterogeneous mass anterior to the uterus
Does Pelvic congestion syndrome more commonly affect the left or right side?
Left
What are the treatments for Pelvic congestion syndrome?
Medical management, litigation of incompetent ovarian vein, ablation of incompetent veins
When does Retained Products of Conception (RPOC) usually occur?
Mostly after 2nd trimester spontaneous abortion, medical termination of the pregnancy
Describe the sonographic appearance of Pelvic congestion syndrome
Multiple dilated peri-uterine and peri-ovarian veins or slow venous flow changing to reversed flow with valsalva
What are some causes/risk factors of ovarian/adnexal torsion?
Ovarian lesion/cyst, pregnancy (1st trimester/immediately postpartum), ovulation induction or hyperstimulated ovaries
What is the complete/partial rotation of an ovary on its vascular pedicle?
Ovarian/adnexal torsion
What is chronic pelvic pain associated with dilatation of the pelvic veins (pelvic varices)?
Pelvic congestion syndrome
What is the location of a subfascial hematoma?
Posterior to the recuts abdominis muscle
What condition is uncommon and sometimes seen 48-96 hours after delivery or miscarriage/abortion?
Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)
When is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) commonly diagnosed?
Postpartum or after miscarriage
How is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) mostly acquired?
Prior uterine instrumentation
Is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) rare or common?
Rare
What is the incomplete expulsion of miscellaneous products of conception?
Retained Products of Conception (RPOC)
Which ovarian vein is more commonly affected with Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?
Right ovarian vein
Describe the sonographic appearance of an abdominal wall endometrial implant
Round hypoechoic mass with internal vascularity
Describe the sonographic appearance of Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM))
Serpiginous tubular structures in the myometrium, color Doppler: moderately increased flow, spectral Doppler: low resistance, high velocity flow
Describe the normal sonographic appearance of a C-section in the initial postpartum period
Small echogenic foci, possibly heterogeneity in LUS
What C-section complication is due to disruption of the inferior epigastric vessels?
Subfascial hematoma
What is the clinical presentation of ovarian/adnexal torsion?
Sudden onset of severe pelvic pain, nausea/vomiting
Can Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) consist with RPOC?
Yes
What is the patient demographic of ovarian/adnexal torsion?
Young women under 30, children with ovarian lesions
Describe the normal sonographic appearance of a C-section after several months
C-section/hysterotomy scar: thin linear echo/hypoechoic line, C-section niche/defect: fluid extending into a triangular defect in anterior LUS
What is the treatment for Retained Products of Conception (RPOC) if the products are large (over 2cm)?
D&C
Describe the sonographic appearance of Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)
Dilated tubular structure extending superiorly from the adnexa, intraluminal echogenic material in ovarian vein with partial/complete absence of flow
Describe the sonographic appearance of a bladder flap hematoma
Heterogenous mass in the LUS
What is the clinical presentation of Pelvic congestion syndrome?
Dull chronic pain
Describe the sonographic appearance of Retained Products of Conception (RPOC)
Echogenic mass/tissue within endometrial cavity, blood flow differentiates RPOC from a blood clot, calcifications
Describe the sonographic appearance of ovarian/adnexal torsion
Enlarged edematous ovary, multiple peripheral follicles, absent venous flow but arterial is variable, twisted/torsed pedicle (grayscale: target sign, color: whirlpool sign)
Describe the normal findings of most C-section deliveries
Transverse incision in LUS
Is ovarian/adnexal torsion usually always unilateral or bilateral?
Unilateral
What is the gold standard for diagnosing Pelvic congestion syndrome?
Venography
What are the causes of Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?
Venous stasis postpartum, spread of puerperal infection
In ovarian/adnexal torsion, is venous/lymphatic flow or arterial flow obstructed first?
Venous/lymphatic flow