Diagnostic ultrasound ( PDFDrive )

CHAPTER
15
The Uterus
Douglas Brown and Deborah Levine
SUMMARY OF KEY POINTS
• Transvaginal ultrasound is usually needed for optimal
assessment of the uterus.
• Uterine enlargement in a nonpregnant patient is most
commonly caused by ibroids or adenomyosis.
• Adenomyosis should be considered when there is an
enlarged globular shape of the uterus; heterogeneity or
asymmetrical thickening of the myometrium; indistinct
interface between the endometrium and myometrium; or
cysts, echogenic striations, or echogenic nodules in the
myometrium.
• Leiomyosarcomas of the uterus overlap in appearance with
much more common leiomyomas and are dificult to
diagnose by ultrasound.
• If an intrauterine device (IUD) is low in the uterus, one
should suspect that one or both arms of the IUD are
embedded in the myometrium.
• Assessment of the fundal contour of the myometrium and
endometrium in the coronal plane using three-dimensional
(3-D) ultrasound is important for diagnosing the most
common müllerian duct anomalies.
• Infrequently the endometrium will not be fully seen on
ultrasound; when this occurs, one should state that it
cannot be reliably measured.
CHAPTER OUTLINE
INTRODUCTION AND SCANNING
TECHNIQUES
NORMAL UTERINE FINDINGS
MÜLLERIAN DUCT ANOMALIES
ABNORMALITIES OF THE
MYOMETRIUM
Leiomyoma
Leiomyosarcoma
Adenomyosis
ABNORMALITIES OF THE CERVIX
ABNORMALITIES OF THE
ENDOMETRIUM
Postmenopausal Endometrium
Hormone Use
Postmenopausal Bleeding
The Obstructed Uterus:
Hydrometrocolpos and
Hematometrocolpos
Endometrial Hyperplasia
Endometrial Polyps
Endometrial Carcinoma
Endometrial Sarcoma
Endometrial Adhesions
Endometrial Ablation
SONOGRAPHY OF CONTRACEPTIVE
DEVICES
Intrauterine Contraceptive Devices
Tubal Occlusion Devices
POSTPARTUM FINDINGS
Normal Findings
Bleeding Postpartum
Retained Products of Conception
Endometritis
Arteriovenous Malformation
Findings After Cesarean Section
Acknowledgment
INTRODUCTION AND SCANNING
TECHNIQUES
Sonography plays an integral role in evaluation of the uterus.
Both transabdominal sonography (TAS) and transvaginal
sonography (TVS) are well-established techniques for assessing
the enlarged uterus and patients with abnormal vaginal bleeding.
he anterior surface of the uterine fundus and body is covered
by peritoneum. he peritoneal space anterior to the uterus is
the vesicouterine pouch, or anterior cul-de-sac. his space is
usually empty, but it may contain small bowel. Posteriorly, the
peritoneal relection extends to the posterior fornix of the vagina,
forming the rectouterine recess, or posterior cul-de-sac. Laterally,
the peritoneal relection forms the broad ligaments, which extend
from the lateral aspect of the uterus to the lateral pelvic side
walls (Fig. 15.1). he round ligaments arise from the uterine
cornua anterior to the fallopian tubes in the broad ligaments,
extend anterolaterally, and course through the inguinal canals
to insert into the fascia of the labia majora.
he cervix is located posterior to the bladder and opens
into the upper vagina through the external os. he vagina is
a ibromuscular canal that lies in the midline and runs from
the cervix to the vestibule of the external genitalia. he cervix
projects into the proximal vagina, creating a space between
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