Pelvic Ultrasound
Space of Retzius
-lies between the pubic symphysis & anterior surface of the urinary bladder.
Small fluid collections found in the Fornix may result from:
-spilled urine/saline -menstrual flow -other uterine discharges
True or false: round ligaments are peritoneal
FALSE! round ligaments are NOT peritoneal.
true or false: the posterior cul de sac is the most superficial space of the pelvis.
FALSE!! the Posterior Cul De Sac is the DEEPEST space of the pelvis.
What do the pelvic muscles act as/ help with?
Helps us by acting as landmarks for VIEWING THE OVARIES
The False pelvis does what?
Houses bowel. *not as important as the true pelvis
The iliopsoas muscles are lateral to what?
Iliopsoas muscles are lateral to the iliac crest.
Round ligaments run from the _____ to the _____ canal
Round ligaments run from uterus to the inguinal canal
true or false: infundibulopelvic ligaments are peritoneal structures.
TRUE! infundibulopelvic ligaments are in fact peritoneal structures.
Where do the infundibulopelvic ligaments extend to & from?
The infundibulopelvic ligaments extend from the fimbriated ends of the fallopian tube to the walls of the pelvis.
The internal obturator muscles are _____ to the psoas muscles.
The internal obturator muscles are INFERIOR to the psoas muscles.
What is the Anterior Cul De Sac?
The space between the bladder & the anterior wall of the uterus.
The uterus is partially covered by _____ & lined with _____ _____(s).
The uterus is partially covered by Peritoneum (broad ligament) & lined with mucous membranes.
The uterus receives the _____ _____(s) from each side at its _____ & ____ borders.
The uterus receives the fallopian tubes from each side at its upper & widest borders.
True or false: the pelvic musculature can be visualized on ultrasound
True the pelvic musculature can be visualized on ultrasound.
The cardinal ligaments anchor the ____ & ____ to the ____ wall.
cardinal ligaments anchor the vagina & cervix to the pelvic wall.
True or false: the iliopsoas muscles CANNOT be seen in both longitudinal & transverse scans.
false. it's seen in both long & transverse. *w/ lateral angulation & bladder midline.
If uterosacral ligaments fail, one may feel _____-_____ pressure which may cause uterine prolapse.
intra-abdominal pressure
What's the sonographic appearance of the levator ani muscles?
levator ani muscles: hypoechoic *hammock-shaped!
The levator ani muscles are ____, ___, & ____ to the obturator internus muscles
levator ani: -medial -caudal -posterior
The space of Retzius lies between the _____ ______ & the _____ surface of the _____ ______.
lies between pubic symphysis & Anterior surface of the urinary bladder.
Characteristics of the piriformis muscles?
short, stubby muscles
the Urinary bladder is _____ to the internal obturator muscles
urinary bladder is medial to the internal obturator muscles.
Uterosacral ligaments pass from _____ to ________
uterosacral ligaments pass from upper end of cervix TO each side of the rectum- ENDS AT SACRUM
Anteflexed uterus
uterus that's bent forward/UPRIGHT
Weakening of the ____ __ muscles, may cause prolapse of pelvic organs.
weakening of the LEVATOR ANI muscles, may cause prolapse of pelvic organs.
Retroflexion
when the cervix is displaced down & forward [backward displacement of the uterus]
Characteristics of the Myometrium
- thick muscular middle layer - forms the MAJORITY of the uterus
Characteristics of the Endometrium
- velvety smooth mucous membrane that is periodically shed/re-grown
What is the purpose of the broad ligaments?
-It covers the uterus -anchors uterus to the pelvic wall. -suspends ovary
Characteristics of the Cervix:
-barrel-shaped -extends downward into upper portion of vagina
Characteristics of the Infundibulum of the fallopian tubes:
-lateral portion -trumpet-shaped -has FIMBRIAE
What's the sonographic appearance of the perimetrium?
-thin, echogenic line that surrounds the uterus.
Characteristics of the The ampulla of the fallopian tube
-widest & longest portion of fallopian tube -thin & strechable -curves over the ovary
What are the 4 pelvic muscles? [IILP]
1) Iliopsoas 2) Internal Obturator 3) Levator Ani 4) Piriformis
What are the (3) other names for the fallopian tubes?
1) Oviducts 2) Uterine tubes 3) Salpinx
What are the 6 pelvic ligaments?
1) broad ligaments 2) infundibulopelvic ligaments 3) round ligaments 4) uterosacral ligaments 5) cardinal (Mackenrodt's) ligaments 6) ovarian ligaments
weakening of these 2 muscles may cause prolapse:
1) levator ani 2) coccygeus muscles
What are the 2 arteries that supply the ovaries?
1) ovarian artery 2) uterine artery
What are the (3) layers of the uterus?
1) perimetrium 2) myometrium 3) endometrium
What are the measurements of the isthmus of the fallopian tube?
2 cm in length 1mm in AP diameter
Bicornuate uterus:
2 endometrial cavities w/ 1 uterus
What's the length/thickness of a Prepubertal uterus?
2-3.3 cm in length 0.5-1 cm in AP diameter
Ovarian size: L x W x AP
3 cm (L) x 2 cm (W) x 2 cm (AP)
What's the length/Width of a Postmenopausal uterus?
3.5-6.5 cm in length 1.2- 1.8 cm wide
What's the length/thickness of a postpubertal uterus?
5-8 cm in length and 1.6 - 3 cm in AP diameter
What's the length/width/thickness of a Nulliparous uterus?
7 cm long 4 cm Wide 4 cm (+ - 1cm) Thick
The uterus measures..
7.5 cm (3 in) x 5 cm (2 in) x 2.5 cm (1 in) +- 1 cm.
What's the length of a vagina?
8-10 cm
What's the length of the fallopian tubes?
8-14 cm long
____ % of ectopic pregnancies are found in the fallopian tubes.
90% of ectopic pregnancies are found in the fallopian tubes.
Anteriorly, the uterus connects the ____, & posteriorly connects the ______.
Anteriorly, the uterus connects the BLADDER, & posteriorly, the CONVEX.
What do the arcuate arteries branch into?
Arcuate arteries branch into the RADIAL ARTERIES
The broad ligament also covers the ____ & the _____.
Covers the Mesosalpinx & Mesovarium.
Where are ectopic pregnancies most commonly found?
Ectopic pregnancies are commonly found in the ISTHMUS of the fallopian tubes.
The external iliac vessels lie ___ to the ovaries.
External iliac vessels lie lateral to the ovaries.
True or false: the iliopsoas muscle is found in the true pelvis.
FALSE the iliopsoas muscle is found in the false pelvis. (mostly)
True or false: Ovarian ligaments are found outside of the broad ligaments.
FALSE the ovarian ligaments are found WITHIN the broad ligaments
True or false: fallopian tubes are normally seen on ultrasound.
FALSE! Fallopian tubes will only be seen if there's a problem. [AKA: Hydrosalpinx]
True or false the interstitial portion of the fallopian tubes are the longest portion.
FALSE! The interstitial portion of the fallopian tubes are the SHORT portion, & minute area of the tubes.
Retroverted uterus
FLAT uterus
The fallopian tubes are _____ structures
Fallopian tubes are paired structures.
True or false: the endometrium is the outermost layer of the uterus.
False! the endometrium is the innermost layer of the uterus.
Where does fertilization occur?
Fertilization occurs at the AMPULLA of the FALLOPIAN TUBES (@ distal portion)
What (problematic) can change the shape of the uterus?
Fibroids/cancerous masses.
hydrometrocolpos
Fluid in the uterus and the vagina
Where is the uterus hollow?
Hollow in the middle.
The fallopian tubes curve: ______, ______ , then _____ to meet with the ____.
Horizontally Outward Backward meet w/ the ovaries.
If not careful, the ____ & the ___ can be mistaken for the ovaries.
If not careful, the priformis & the iliopsoas muscles can be mistaken for the ovaries.
The iliac vessels are ____ to the ovaries
Iliac vessels = POST to the ovaries
The iliopsoas muscle has an _____ center.
Iliopsoas muscle has an ECHOGENIC center
The innominate bones of the pelvis consist of:
Ilium, ischium, & pubic bones.
It's important to see what prior to the 8th week of pregnancy?
Important to see a CORPUS LUTEUM CYST! *This sustains the pregnancy in the early stages
The infundibulum is in direct contact with the ____.
Infundibulum in direct contact with the ovary.
uterine artery branches off of the
Internal iliac artery
The internal iliac vessels lie ___ to the ovaries
Internal iliac vessels lie posterior to the ovaries
Sonographically, the internal obturator muscles appear ____ to the urinary bladder
Internal obturator muscles appear hypoechoic to the urinary bladder.
The internal obturator muscles are ____ to the ovaries
Internal obturator muscles are lateral to the ovaries.
The internal obturator muscles are best seen in what plane?
Internal obturator muscles best seen in Transverse plane with superior angulation at the symphysis pubis.
The true pelvis does what?
It contains the reproductive structures *Lies more inferior than the false pelvis
Multiparous
Lady who's been pregnant MORE THAN ONCE
Nulliparous
Lady who's never been pregnant.
LMP
Last Menstrual Period. [refers to last FIRST DAY of that period]
The left ovarian vein drains directly into the ___ __ ___.
Left Ovarian Vein drains into the Left renal vein
The ovarian ligaments extend from each ovary to the ____ side of the uterus.
Ovarian ligaments extend from each ovary to the LATERAL side of the uterus.
Venous drainage of the ovaries is done by the:
Ovarian vein
Ovarian volume ranges from _____ to ____ in postpubertal girls:
Ovarian volume in POSTPUBERTAL girls: 1.8 mm (cc) to 5.7 mm (cc) **(up to 6 cc)
Ovarian volume ranges from _____ to ____ in PREPUBERTAL girls:
Ovarian volume in PREPUBERTAL girls: .13 mm - .9 mm
The ovaries are ____ to the internal obturator muscles.
Ovaries are medial to the internal obturator muscles.
The ovaries are medial to what pelvic muscles?
Ovaries are medial to the obturator internus muscles.
The ovaries lie ___ to the internal iliac vessels
Ovaries lie anterior to the internal iliac vessels
The ovaries lie ____ to the external iliac vessels
Ovaries lie medial to the external iliac vessels.
Ovaries should NOT exceed ____ in length.
Ovaries should not exceed 5cm in length!
Sonographically, the ovaries will be equal to or more ____ compared to the uterus.
Ovaries: equal to, or more echogenic in comparison to the uterus.
The ovaries are ____ to the internal iliac vessels
Ovaries= ANTERIOR to the internal iliac vessels.
The ovary's main blood supply is from:
Ovary's blood supply comes from the ovarian artery
Mesosalpinx
Part of the FALLOPIAN TUBE that's covered by the broad ligament.
Mesovarium
Part of the OVARY covered by the broad ligament.
The pelvic ligaments support what 3 structures?
Pelvic ligaments support 1) ovaries 2) uterus 3)fallopian tubes
The pelvic muscles prevent what from occurring?
Pelvic muscles prevent prolapse of the uterus from taking place.
The piriformis muscle lies ____ in the pelvis.
Piriformis muscle lies POSTERIORLY in the pelvis.
The bilateral muscles located posterior to & extend from the sacrum to the femoral greater trochanter are the:
Piriformis muscles
Pyosalpinx
Pus within the fallopian tube
The RT & LT uterine arteries are branches of the ____ ____ _____.
RT/LT uterine arteries are branches of the INTERNAL ILIAC ARTERIES.
What's another term for the posterior cul-de-sac?
Rectouterine pouch OR pouch of douglas
Rectus abdominis muscle is located ____ in the pelvis.
Rectus abdominis located anteriorly
What does the round ligament support?
Round ligaments support the uterine fundus.
What arteries supply the functional layer of the endometrium?
SPIRAL ARTERIES supply the functional layer of the endometrium
The radial arteries divide into the straight, & spiral arteries. Which of these supplies the functional layer of the endometrium?
SPIRAL ARTERIES.
When are the broad ligaments usually seen in patients?
Seen in patients that have acites or an extremely over-filled bladder.
The shape of the uterus varies with...
Shape varies with age.
Sonographically, the basal layer will appear _____.
Sonographically, basal layer is HYPOECHOIC on ultrasound due to the BV's within!
Space of retzius is lacated between the:
Space of Retzius is between the bladder & pubic bone
Where is the space of retzius located?
Space of retzius is located between bladder & pubic symphysis
Where do the suspensory ligaments extend from?
Suspensory ligaments extend from the OVARIES to the PELVIC SIDE WALLS
True or false: the ovaries have a DUAL blood supply.
TRUE! ovaries have a dual blood supply.
True or false: follicular size ranges from 5-24 mm.
TRUE! the ovarian follicles range in size from 5-24 mm [or, .5- 2.4 cm]
T/F the uterus is a retroperitoneal organ
TRUE, UT = retroperitoneal organ.
On transverse scans, the vagina is _____ positioned.
TRV scans, vagina is: horizontally positioned.
Which muscle(s) make up the muscular floor of the true pelvis?
The Piriformis muscles make up the floor of the TRUE pelvis
What is another name for the posterior cul de sac
The Pouch of Douglas
Which division makes up most of the ovary?
The cortex makes up most of the ovary.
The internal iliac vessels are ___ to the ovaries.
The internal iliac vessels are POSTERIOR to the ovaries.
The pelvic diaphragm includes the ____ ___ & _____ muscles
The pelvic diaphragm includes both the LEVATOR ANI & the COCCYGEUS muscles.
What muscles may be confused with the ovaries?
The piriformis & iliopsoas muscles might be confused with the ovaries.
The vagina is positioned ____ in relation to the urethra
The vagina is positioned POSTERIORLY in relation to the urethra.
The total thickness of the endometrial stripe should NOT exceed ___ postmenopausal.
Thickness of endometrial stripe should not exceed 5 mm POSTMENOPAUSAL
The total thickness of the endometrial stripe should NOT exceed ____ when premenopausal.
Thickness of endometrial stripe should not exceed 14-16 mm premenopausal
True or false: blood tends to pool (after surgery) in the space of retzius
True! Blood does tend to pool in the space of retzius.
True or false: the endometrium can enlarge to 16 mm AP.
True! The endometrium can get up to 16 mm in AP diameter.
True or false: In new-borns, the cervix tends to be bigger than the fundus.
True! the cervix is bigger than the fundus.
True or false: in the 2nd trimester, the cervix should remain CLOSED
True! the cervix should remain closed. If open/weak, woman will be put on bed rest to avoid pre-mature delivery.
True or false: the female pelvis is lined by muscles.
True! the female pelvis is lined by muscles.
True or false: the interstitial portion of the fallopian tubes are commonly seen on pelvic ultrasound.
True! the interstitial portion of the fallopian tubes are commonly seen on pelvic ultrasound.
True or false: the pelvis can be divided into anterior & posterior compartments
True! the pelvis is divided into anterior & posterior compartments.
True or false: uterosacral ligaments are fibromuscular cords.
True! uterosacral ligaments are in fact fibromuscular cords.
True or false, the iliac vessels will appear tubular & anechoic on an ultrasound
True, the iliac vessels will appear tubular & anechoic on ultrasound.
True or false: the levator ani muscle is the most caudal structure of the pelvic cavity.
True. The levator ani muscle is the most caudal structure of the pelvic cavity
True or false: it's common to have fluid (due to overdistension of urinary bladder) in the anterior cul de sac
True. it's common to have fluid in the anterior cul de sac.
True or false the internal obturator muscles are slim & cylindrical
True. the internal obturator muscles ARE slim & cylindrical
True or false: after age 65, the uterus atrophies and returns to infantile size.
True. the uterus will return to infantile size.
True or false: the uterus shape is the same in both infants and adults.
True. this is due to mature hormonal stimulation due to placental/maternal blood.
The uterus is bound laterally by the ______ ligaments.
UT is bound laterally by the BROAD LIGAMENTS
uterus lies ___ to bladder
UT lies posterior to bladder
The urinary bladder lies directly behind the _____ bone
Urinary bladder lies behind the pubic bone
What supplies the uterus?
Uterine arteries
What drains the uterus?
Uterine veins
What's the venous circulation of the female pelvis? [from uterus TO IVC)
Uterine veins (thru cardinal ligament)--> internal iliac vein--> common iliac vein --> IVC
Where does the uterosacral ligament extend from?
Uterosacral ligament extends from uterus to sacrum.
What does the uterosacral ligament support?
Uterosacral ligament supports the UTERUS
What's the function of the uterosacral ligaments?
Uterosacral ligaments: hold cervix up & back -helps maintain ANTEFLEXION
Uterosacral=
Uterus + sacrum=uterosacral
The uterus has _____-______ echoes.
Uterus has mid-level echoes.
The uterus is anterior to the _____.
Uterus is anterior to the rectum.
The vagina lies ____ & angles downward from the ____.
Vagina lies anteriorly & angles downward from the CERVIX
the ____ ____ envelope the inferior aspect of the cervix.
Vaginal fornices envelope the inferior aspect of the cervix.
Fluid noted anterior to the UT would most likely be loacated within the:
Vesicouterine pouch
What's another term for the anterior cul-de-sac?
Vesicouterine pouch
Where is the Vesicouterine pouch (anterior cul-de-sac) located?
Vesicouterine pouch is ANTERIOR to the uterus & POSTERIOR to the urinary bladder.
When surrounded by free fluid, the dense broad ligaments may be seen as _____ structures.
When surrounded by free fluid, the dense broad ligaments may be seen as ECHOGENIC structures.
The ovarian ligaments attach between the ____ & the ________ ligament.
attaches between the OVIDUCT (fallopian tube) & the ROUND ligament.
The cardinal ligaments are continuous with the ______ ligaments.
cardinal ligaments are continuous with the uterosacral ligaments.
In an adult, the cervix should not be bigger than the _____.
cervix should NOT be bigger than the Fundus of the uterus.
When the vaginal walls are compressed, the appearance on ultrasound will be:
compressed vaginal walls: echogenic thin line!
Iliacus muscle + psoas muscle =
iliopsoas muscle!
iliopsoas muscles are located ___ & ____ to the iliac crest
iliopsoas muscles are located LATERAL & ANTERIOR to the iliac crest.
ovarian ligaments extend from:
ovarian ligaments extend from the ovary to the lateral surface of the uterus.
The ovaries are ____ to the iliac vessels
ovaries are ANT to the iliac vessels
Uterus
pear-shaped thick MUSCULAR walls low cavity/canal
The anterior wall of the vagina is in contact with the ___ in its lower third.
the anterior wall of the vagina is in contact with the URETHRA in its lower third.
The Fornix
the area around the cervix as it lies in the vaginal vault
Fundus of Uterus
the base of the uterus - most SUPERIOR & rounded portion -connects with the fallopian tubes on either side
What is the space of retzius?
the space between the bladder & abdominal wall [filled with adipose tissue]
What are the Fornices?
the space between the cervix & the vagina
What plane is the best for visualizing the levator ani muscles?
the transverse plane is the best for viewing the levator ani muscles with inferior angulation.
Sonographically, the urinary bladder appears ____ to the internal obturator muscles
urinary bladder appears hyperechoic to the internal obturator muscles.
The uterus lies between the _____ & _____.
uterus lies between the bladder & rectum.
What's the length/thickness of a Multiparous uterus?
**ALL sizes of nulliparous, BUT increase by 1.2 cm
Characteristics of the Medulla of the Ovary:
- central portion of ovary - contains BV's & CT
Sonographically, the bladder can be used to achieve the following goals:
- lift soft tissue structures into the false pelvis - displace the uterus 45-90 degrees toward the transducer - displace loops of sound-inhibiting bowel
Characteristics of the cortex of the ovary:
- outer portion of the gland - contains glandular tissue & follicles
Characteristics of the Perimetrium
- outer smooth covering - AKA "serosa" or "perimetrium" - covers fundus, body, & up to isthmus
The indications for pelvic ultrasound:
- palpable pelvic mass (ovarian) -enlarged uterus -pelvic pain -vaginal bleeding -infertility -localization of IUCD's [intrauterine contraceptive devices] -monitoring for follicular development -possible ectopic pregnancy -guidance for interventional procedures
Characteristics of the ovaries:
-paired -almond-shaped glands
Measurements of the Interstitial portion of the fallopian tubes:
1 cm in length 1mm in AP diameter
4 sections of the uterus
1 fundus 2 corpus 3 isthmus 4 cervix
What are the 4 pelvic spaces that MUST be routinely evaluated by sonographers:
1) Anterior Cul De Sac 2) Posterior Cul De Sac 3) Fornices 4) Space of Retzius
What are the (2) layers of the endometrium?
1) Basal layer 2) Functional layer
What (2) parts can the ovaries be divided into
1) Cortex 2) Medulla
What are the 2 divisions of the pelvis?
1) False pelvis (Major) 2) True pelvis (Minor)
What are the (4) parts of the uterus?
1) Fundus 2) Corpus 3) Isthmus 4) Cervix
1 cc is equivalent to:
1mm = 1 cc
RT ovarian artery branches off the:
AORTA
____ arteries are the branches of the uterine artery.
ARCUATE ARTERIES are branches of the uterine artery.
In the female reproductive system, the blood supply from the abdominal aorta branches into the paired ____ ____ ____.
Abdominal AO branches into the COMMON ILIAC ARTERIES (**near umbilicus)
What ultimately supplies the blood to the female genitalia?
Abdominal aorta supplies the blood to the female genitalia
Peritoneal spaces located posterior to the broad ligament are referred to as the:
Adnexa
The adnexa is anything between the _____ & the ____ _____.
Adnexa: anything between Uterus & Pelvic bone
How do you differentiate between an ovarian cyst & an ovarian follicle?
An ovarian cyst is > 2.4 cm (> 24 mm) An ovarian follicle is < 2.4 cm (< 24 mm)
The fornix can be divided into the _____,_______, & _____ fornices
Anterior, Posterior, & Lateral Fornices.
Pelvic ligament that extends from the lateral aspect of the uterus to the sidewalls of the pelvis is the:
BROAD LIGAMENT
Most common structural defect of the uterus
Bicornuate uterus
What's within the true pelvis?
Bladder Fallopian tubes Uterus Ovaries Rectum Sigmoid colon
The broad ligaments support what 3 structures?
Broad Ligaments support: 1) uterus 2) tubes 3) ovaries
Where do the broad ligaments extend from?
Broad ligaments extend from the lateral aspect of the uterus to the side walls of the pelvis
The fallopian tubes attach to the uterine fundus, or ____ and extend downward to encircle the _____
CORNUA OVARY
Where does the cardinal ligament extend from?
Cardinal ligament extends from LATERAL surface of cervix to LATERAL fornix of vagina
The ligament that houses the VASCULATURE of the uterus is the
Cardinal ligament houses the vasculature of the uterus.
What does the cardinal ligament support?
Cardinal ligament supports the cervix.
What do the common iliac arteries branch into?
Common iliac arteries branch into external & internal iliac arteries
What does the cortex of the ovary produce?
Cortex produces estrogen & progesterone
The isthmus portion of the fallopian tube is the ____ portion of the fallopian tube.
Isthmus portion of fallopian tubes = MEDIAL portion of fallopian tubes.
Why is it difficult to find the ovaries?
It's difficult because the fallopian tubes MOVE!
Ovarian size equation:
L x W x H (0.52) =
Pelvic muscle group that is located between the coccyx and the pubis is the:
LEVATOR ANI MUSCLES
What divides the false pelvis from the true pelvis?
Linea terminalis
What's the other name for the cardinal ligament?
Mackenrodt's ligaments or, transverse cervical ligaments
Gravidity
Number of times one's been pregnant (G1 P0)
The pelvic ligament that provides support to the ovary, and extends from the lateral surface of the ovary to the UT is the:
OVARIAN LIGAMENT
the obturator internus lies ___ to the ovaries.
Obturator internus lies LATERAL to the ovaries.
What muscles are lateral to the ovaries?
Obturator internus muscles lie lateral to the ovaries.
Ovarian arteries originate from the ____ aspect of the abdominal aorta.
Ovarian arteries originate from the LATERAL aspect of the abdominal aorta
Where do the ovarian ligaments extend from?
Ovarian ligaments extend from ovaries to lateral surface of the uterus
What do the ovarian ligaments support?
Ovarian ligaments support the ovaries
The round ligaments extend from...
Round ligaments extend from the uterine cornua to the labia majora- between the folds of the broad ligament
uterus lies ____ to the rectum.
UT lies anterior to rectum
Isthmus
a slight constriction between the body & cervix
Vagina
a thin-walled tube
Postmenopausal
after menopause
Postpubertal
after puberty/ never been pregnant.
The fallopian tubes allow for passage of...
allows for passage of egg from ovary --> uterus
In a nulliparous female, the Corpus is generally _____ & or ____
anteflexed (bent forward) & anteverted (folded over)
What does the anterior compartment of the pelvis house?
anterior compartment houses the bladder & the majority of the reproductive organs.
Define prepubertal
before puberty.
Sonographically, what's the best plane for viewing the endometrial stripe?
best plane for viewing endometrial stripe: long
The anterior wall of the vagina is also in contact with the middle third of the ____.
bladder.
hematometrocolpos
blood in the uterus & vagina
You cannot see the uterus without the ____ distended.
cannot see uterus without bladder distended!
The cardinal ligaments are lateral to the ____ & _____
cardinal ligaments are lateral to the cervix & vagina
Immediately post-menstrual:
days 0-5 BLEEDING thin, hyperechoic line
Secretory phase
days 15-28 endometrium thickens Hyperechoic!
Proliferative phase
days 6-14 rise in LH
Hydrosalpinx
distended fallopian tube filled with water
What is the endocervical canal lined with?
endocervical canal is lined with a mucous membrane arranged in folds of raised tissue
The endometrium should NOT be less than ___mm
endometrium should not be less than 6mm. BAD
True or false: the pelvic ligaments are normally visualized on ultrasound.
false. the pelvic ligaments are NOT normally visualized on an ultrasound.
What sized follicles are seen at ovulation?
follicles .6- 1.5 cm in diameter can be seen at ovulation
What's the role of the round ligaments?
holds the uterus in its proper position **if they fail, MAY CAUSE PROLAPSE
What's the sonographic appearance of the myometrium?
homogenous low to mid-level echoes
In transverse scans, the iliopsoas muscle is found at the level of...?
iliopsoas muscle found at the level of the Umbilicus
The iliopsoas muscle is located by the ____ within the _____ pelvis
iliopsoas muscle is located by the BLADDER, within the FALSE PELVIS
What's the sonographic appearance of the iliopsoas muscles?
iliopsoas muscles: hypoechoic rim & echogenic center
The paired muscles located lateral to the uterus and anterior to the iliac crest are:
iliospoas muscles
The infundibulopelvic ligaments are continuous with:
infundibulopelvic ligaments are continuous with peritoneum on the pelvic floor.
What's the number one landmark for an ovary?
internal iliac vessels! Ovaries will be ANTERIOR
the internal obturator muscles are _____ to the urinary bladder
internal obturator muscles are lateral to the urinary bladder.
The interstitial portion of the fallopian tube is encased within :
interstitial portion of the fallopian tube is encased within the: Broad ligament
What's the sonographic appearance of the endometrial stripe?
linear highly echogenic it's thickness changes based on the menstrual cycle.
Anteverted uterus
normal view of the uterus. /folded over
Parity
number of live births
Muscle located lateral to the ovaries:
obturator internus
Ectopic pregnancies occur:
occur anywhere outside of the endometrium.
What does the ovarian artery branch from?
ovarian artery branches from the internal iliac artery
the pelvic ligament that provides support to the ovary and extends from the ovary to the lateral surface of the uterus is the:
ovarian ligament
The ovarian ligaments anchor the ovaries to the _____
ovarian ligaments anchor ovaries --> uterus.
Pelvis muscles will appear ____ with varying degrees of ____ muscle fibers on ultrasound.
pelvic muscles will appear HYPOECHOIC with varying degrees of HYPERECHOIC muscle fibers (seen in LO/TRV)
What are broad ligaments?
peritoneal folds that cover the uterus.
What does the posterior compartment house?
posterior compartment houses the recto-sigmoid
The Posterior Cul De Sac lies ____ & ____ to the rectum.
posterior cul de sac: -posterior & anterior to the Rectum
The posterior surface of the vagina is in contact with the ____.
posterior surface of vagina is in contact with the rectum
Radial arteries branch into ___ arteries & ____ arteries.
radial arteries branch into STRAIGHT ARTERIES & SPIRAL ARTERIES
Salpinx
refers to, 1 fallopian tube
What's the role of the pelvic ligaments?
role of pelvic ligaments: to anchor the uterus
The uterus should not exceed... in length
should NOT exceed 8.5 - 9 cm in length
Ovarian volume should NEVER exceed ____ in postmenopausal women.
should never exceed 4 mm in postmenopausal women.
The bladder is anterior to the ____.
the bladder is anterior to the uterus.
Corpus of uterus
the body of the uterus -most movable portion
Another name for cervical canal
the endocervical canal
internal os
the junction between the cervical canal & uterine cavity
External os
the junction between the cervical canal and the vagina
Isthmus of uterus
the neck of uterus
The pelvic diaphragm lies ____ to the vagina in transverse.
the pelvic diaphragm lies INFERIOR to the vagina in transverse.
What's the Cornu?
the place where the fundus of the uterus meets the fallopian tubes.
The rectum is posterior to the _____.
the rectum is posterior to the uterus.
what do the suspensory ligaments support?
the suspensory ligaments support the ovaries & the tubes
The uterus is ____ to the bladder.
the uterus is Posterior to the bladder.
True or false: the vagina is best seen in the longitudinal plane.
true, the vagina is best seen in the longitudinal plane.
Round ligaments are truly:
truly fibromuscular cords.
Vaginal vault
upper portion of the vagina
Retroflexed uterus
uterus facing straight down
What's the sonographic appearance of the uterus?
uterus is echogenic, BUT will change between cycles.
The vagina lies parallel to the ____.
vagina = parallel to urethra
Anterior cul de sac also called:
vesicouterine pouch