Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 533
A
B
FIG. 15.4 Myometrial Veins. (A) Sagittal TVS shows prominent veins in the outer myometrium. A few had low demonstrated on Doppler
imaging, but many did not have detectable low on Doppler (two indicated by arrows), owing to slow velocity of low. Real-time imaging showed
movement of echoes within these veins. (B) Another similar example. There is luid in the pelvis surrounding the uterus.
FIG. 15.5 Arcuate Artery Calciications. Sagittal TVS demonstrates multiple echogenic foci in the outer myometrium due to arcuate artery
calciications. A normal thin endometrium is also noted in this postmenopausal patient (calipers centrally).
Myometrial contractions, although more commonly seen
during pregnancy, can occasionally be seen in the inner myometrium
of nonpregnant women. 47 However, these are subtle
contractions and in general not as large or as likely to be mistaken
for pathology as may occur during pregnancy.
Tiny echogenic foci, oten without acoustic shadowing, may
be present in the inner myometrium near the endometrial/
myometrial interface (Fig. 15.6). Few data are available for this
inding, but it seems to be of no clinical importance and may
be due to dystrophic calciication related to prior uterine
instrumentation. 48
he cervix frequently contains cysts, most of which are mucous
retention cysts and are commonly termed nabothian cysts. hey
oten appear as simple cysts but may occasionally have internal
echoes in the cyst luid (Fig. 15.7). Although variable in size and
number, most nabothian cysts are small and of no clinical
importance. 49 Mucosal folds in the cervix, termed plicae palmatae,
are more commonly seen with MRI but may occasionally be
seen with TVS (see Fig. 15.7E). Tiny echogenic foci may also
be seen in the inner portion of the cervix and are likely due to
punctate calciications (see Fig. 15.7F). hese may be related to
prior uterine instrumentation and are considered a benign
inding. 50 he inner part of the cervix may also appear slightly
hypoechoic compared with the outer cervix and possibly simulate
a mass (Fig. 15.8). he uniform elongated nature of this inding
should help distinguish it from a true mass.
MÜLLERIAN DUCT ANOMALIES
he fused caudal ends of the two müllerian (paramesonephric)
ducts form the uterus, cervix, and upper two-thirds of the vagina.
Fusion typically occurs in the medial portion of the ducts and