Abnormally thickened endometrium on imaging may occur for a number of reasons which may be categorized based on whether or not they are related to pregnancy. Etiologies may also be classified based on whether the patient is premenopausal or postmenopausal.
Cystic retroperitoneal lesions can carry a relatively broad differential, which includes:
retroperitoneal mucinous cystadenoma
retroperitoneal cystic teratoma
retroperitoenal cystic mesothelioma
pseudomyxoma retroperitonei with cystic change
perianal mucinous c...
The cul-de-sac, also known as the pouch of Douglas or rectouterine pouch, is an extension of the postero-inferior reflection of the peritoneal fold between the uterus (anteriorly) and rectum (posteriorly). It is the most inferior aspect of the peritoneal cavity and therefore the first location w...
Fluid in the endometrial cavity can result from a number of causes if excessive and associated with distension.
There are essentially three types of fluid:
hydrometra: simple fluid
hematometra: hemorrhagic content / clot
normal (i.e. physiological)
Endometrial microcalcifications can arise from a vast range pathologies but are usually of benign in etiology.
They have an increased incidence with older age, postmenopausal state, atrophic endometrium, and endometrial polyps.
In some cases they are associated wit...
Ovarian epithelial tumors account for the majority of all ovarian tumors (60-70%) and their malignant forms represent >90% of ovarian cancers 1. They can range from being benign to highly malignant.
There is a difference in frequency of ovarian tumor subtypes depending on menopaus...
Female infertility is common and can be due to a number of factors. Radiology often plays a key part in the work-up.
Often more than one factor (including male infertility) is the cause of infertility, some of the common causes are listed below 1-3:
age > 35 years
Frontal bossing is a calvarial radiographic feature where the front of the skull appears protruding anteriorly. It is best appreciated on a sagittal or lateral image.
This feature can be seen in many conditions (in alphabetical order):
It is important to have a systematic way of approaching a case with subfertility in the exam.
Ultrasound is the initial examination of choice. Always say that you would further assess the uterus with 3D ultrasound. You may also say that in my department we would perform a sonohysterogram or HS...
Malignant neoplasms involving the uterus account for a significant proportion of all female cancers.
They can be classified as:
endometrial carcinoma : commonest: >90% of all uterine malignancies
endometrioid carcinoma of the uterus: commonest histological type, ~80%
papillary serous carcino...
Ovarian cystic neoplasms can be either benign or malignant and can arise from epithelial, stromal, or germ cell components. In general, the risk of malignancy in unilocular cystic tumors <10 cm in women over the age of 50 years is thought to be low 3-4.
ovarian mature cystic teratoma
A hypointense ovarian lesion on T2 weighted MRI is usually a sign of benignity. The low signal is considered to be due to fibrosis and blood products 1.
Lesions that can give this appearance include 1:
Ovarian tumors are relatively common and account for ~6% of female malignancies. This article focuses on the general classification of ovarian tumors. For specific features, refer to the subarticles.
Primary ovarian tumors
Surface epithelial-stromal ovarian tumors (60-70%)...
There are several ovarian tumors associated with endometrial thickening and is often due to oestrogenic effects of the ovarian tumor.
Such tumors include:
ovarian epithelial tumors
endometroid carcinoma of the ovary
may have synchronous endometrial carcinoma or endometrial hyperplasia, prese...
Pelvic masses in females carry a broad differential diagnosis:
benign adnexal cyst: 34%
pelvic malignancy: 14%
pelvic inflammatory disease: 8%
Extra-gynecological masses, e.g. colorectal carcinom...
It is important to have a systematic way of approaching a case with pelvic pain in the exam.
Most examinations are performed using ultrasound. Always say that you would further assess the uterus with 3D ultrasound. You may also say that in my department we would perform a sonohysterogram. Only...
Perigestational hemorrhage refers to hemorrhage that occurs around the fetus during the gestational period. The spectrum of hemorrhage includes:
chorionic hemorrhage: caused by the separation of the chorion from the endometrium
subchorionic hemorrhage: most common type, occurs between the cho...
It is important to have a systematic way of approaching a case with per vaginal bleeding in the exam.
intrauterine fetal demise
PET-CT is a combination of cross-sectional anatomic information provided by CT and the metabolic information provided by positron emission tomography (PET).
PET is most commonly performed with 2-[F-18]fluoro-2-deoxy-D-glucose (FDG). Fluorine-18 (F-18) is an unstable radioisotope and has a half-...
Placentomegaly is a term applied to an abnormally enlarged placenta.
It can be associated with a number of maternal and fetal disorders which include:
chronic intrauterine infections
Polyhydramnios refers to a situation where the amniotic fluid volume is more than expected for gestational age.
It is generally defined as:
amniotic fluid index (AFI) >25 cm
largest fluid pocket depth (maximal vertical pocket (MVP)) greater than 8 cm 6: although some centers, particularly in ...
Primary peritoneal neoplasms comprise an uncommon group of heterogeneous entities, which include:
primary (malignant) peritoneal mesothelioma
peritoneal multicystic mesothelioma
primary peritoneal well-differentiated papillary mesothelioma
primary peritoneal adenomat...
Pyometrium refers to infection of the endometrial cavity with resulting expansion due to accumulated pus (pyometra).
The postmenopausal demographic are most commonly affected due to the association with uterine malignancy.
endometritis / pelvic inflammatory disease
Rhizomelic dwarfism is a type of dwarfism where the dominant feature is proximal (i.e. femoral, humeral) limb shortening.
The following conditions fall under the heading of rhizomelic dwarfism 3
rhizomelic chondrodysplasia punctata
Right iliac fossa mass is a common clinical presentation and has a range of differentials that need to be excluded. Radiology plays an important role in this differentiation.
Shorted fetal femur is a morphological descriptor and is usually defined when the femoral length falls below the 5th centile for gestational age (some define it when it is under the 2.5th centile 5) or less than 0.91 predicted by the bi-parietal diameter. It can occur in isolated or in associati...
Short umbilical cord has been variably defined. Considering the mean length of the umbilical cord is 50-70 cm 1-2, a short cord in absolute terms is usually taken as one that is under 35-40 cm in length at term 1-2.
Recognized associations include
A Sister Mary Joseph nodule is a metastatic lesion involving the umbilicus. The most common primary source is an intra-abdominal adenocarcinoma.
Umbilical metastases are uncommon, reportedly present in 1-3% of all intra-abdominal and/or pelvic malignancy 7.
Soft-tissue sarcomas are a heterogeneous group of malignant tumors of mesenchymal origin (sarcoma) that originate from the soft tissues rather than bone. They are classified on the basis of tissue seen on histology. The commoner sarcomas in the adult and pediatric population are listed below.
Obstetric and gynecological ultrasound is rampant with numerous cut off values. Some of these get revised over the years. The following list is a useful aid to refer to and revise.
rate of increase of a mean sac diameter per day in early pregnancy
generally accepted value for a thi...
Syndactyly (plural: syndactylies) refers to a congenital fusion of two or more digits. It may be confined to soft tissue (soft tissue syndactyly/simple syndactyly) or may involve bone (bony syndactyly/complex syndactyly).
The overall estimated incidence is at ~1 per 2,500 to 5,000...
Uterine enlargement can occur in a number of situations from both diffuse and focal processes. These include:
gestation related events
normal intrauterine pregnancy
molar pregnancy - gestational trophoblastic disease
postpartum uterus - still larger than usual
The Valsalva maneuver is the forced expiration of air against a closed airway, resulting in increased intra-abdominal, intrathoracic and pharyngeal pressure. It can be performed against a closed glottis or by one closing the mouth and pinching the nose while forcibly exhaling.
It is commonly us...
Vulval neoplasms are rare and mostly seen in elderly female patients. Squamous cell carcinoma (SCC) is the most common malignancy of the vulva and only 30% of them are associated with oncogenic human papillomaviruses (HPVs).
Squamous neoplastic lesions