Diagnostic ultrasound ( PDFDrive )

CHAPTER 16 The Adnexa 565
Fallopian
tube
Uterine
fundus
Isthmus
Pampiniform
plexus
Arcuate and
radial branches
Infundibulum
Cornua
Uterine
body
Mesosalpinx
Ampulla
Ovarian
vessels
Fimbriae
Ovary
Ovarian
ligament
Cervix
Broad
ligament
Mesovarium
Suspensory
ligament of
ovary
FIG. 16.1 Normal Gynecologic Organs. Diagram of uterus, ovaries,
tubes, and related structures. On left side, broad ligament has been
removed.
Ovarian
artery and vein
A
Uterine
artery and vein
Utero-ovarian
ligament
Infundibulo-pelvic
ligament
forms the broad ligaments, which extend from the lateral aspect
of the uterus to the lateral pelvic side walls (Fig. 16.1). Encompassing
the superior and lateral margin of the broad ligament is the
suspensory (infundibulopelvic) ligament. he free border of
the broad ligament contains the fallopian tube within its superior
margin, which is referred to as the mesosalpinx. he ovary is
attached to the posterior layer of broad ligament by relections
of peritoneum called the mesovarium. 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. 1
Each fallopian tube varies from 7 to 12 cm in length and is
divided into intramural, isthmic, ampullary, and infundibular
portions. he intramural, or interstitial, portion is approximately
1 cm long, is contained within the muscular wall of the uterus,
and is the narrowest part of the tube. he isthmus, constituting
the medial third, is slightly wider, round, cordlike, and continuous
with the ampulla, which is tortuous and forms approximately
one-half the length of the tube. he ampulla terminates in the
most distal portion, the infundibulum, or imbriated end, which
is funnel shaped and opens into the peritoneal cavity. 2
he ovaries are elliptical in shape, with the long axis usually
oriented vertically. he surface of the ovary is not covered by
peritoneum but by a single layer of cuboidal or columnar cells
called the germinal epithelium, which becomes continuous with
the peritoneum at the hilum of the ovary. he internal structure
of the ovary is divided into an outer cortex and inner medulla.
he cortex consists of an interstitial framework, or stroma, which
is composed of reticular ibers and spindle-shaped cells and which
contains the ovarian follicles and corpus lutea. Beneath the
germinal epithelium, the connective tissue of the cortex is
condensed to form a ibrous capsule, the tunica albuginea. he
medulla, which is smaller in volume than the cortex, is composed
of ibrous tissue and blood vessels. In the nulliparous female,
the ovary is located in a depression on the lateral pelvic wall
called the ovarian fossa, which is bounded anteriorly by the
obliterated umbilical artery, posteriorly by the ureter and the
internal iliac artery, and superiorly by the external iliac vein. 2
he imbriae of the fallopian tube lie superior and lateral to the
B
FIG. 16.2 Adnexal Vascularity. (A) Diagram of uterine artery along
the lateral margin of the uterus and the ovarian artery seen lateral to
the ovary within the right adnexa, both joining to form the pampiniform
plexus anterior to the ovary. (B) Transverse color Doppler image demonstrating
the ovarian artery (right arrow), uterine artery (left arrow), and
pampiniform plexus (middle arrow) of the right adnexa.
ovary. he anterior surface of the ovary is attached to the posterior
surface of the broad ligament by the short mesovarium. he
upper pole of the ovary is attached to the lateral wall of the pelvis
by the lateral extension of the broad ligament, the suspensory
(infundibulopelvic) ligament of the ovary. Arising from the
uterine cornu posteriorly to the tubes and attaching to the inferior
aspect of the ovary is the utero-ovarian ligament. hese ligaments
are not rigid, and therefore the ovary can be quite mobile,
especially in women who have had pregnancies and/or who have
had a hysterectomy.
he vascularity to the adnexa consists of a dual blood supply.
he ovary is chiely supplied by the ovarian artery, a branch of
the hypogastric (internal iliac) artery but usually receives additional
arterial low from the ovarian branches of the uterine
artery (Fig. 16.2). he veins tend to parallel the arteries.
From the ovarian pampiniform plexus, the right ovarian vein
drains directly into the inferior vena cava, while the let ovarian
vein empties into the let renal vein. he ovarian ligaments that
include the broad ligament, the ovarian ligament, and the
infundibulopelvic ligament contain vascular, lymphatic, and
nervous supplies to the organs. he ovarian nerves and vessels