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    Reproductive Radiology

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    This document summarizes male and female reproductive radiology. For males, it describes normal ultrasound findings and abnormalities like epididymitis, hydrocele, varicocele, and testicular torsion or carcinoma. For females, it outlines pelvic ultrasound and MRI to evaluate the uterus and ovaries, describing normal anatomy and abnormalities such as fibroids, adenomyosis, cysts, and endometrial thickening. Imaging plays an important role in evaluating reproductive organs and detecting abnormalities.

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    Reproductive Radiology

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    6 views7 pages
    This document summarizes male and female reproductive radiology. For males, it describes normal ultrasound findings and abnormalities like epididymitis, hydrocele, varicocele, and testicular torsion or carcinoma. For females, it outlines pelvic ultrasound and MRI to evaluate the uterus and ovaries, describing normal anatomy and abnormalities such as fibroids, adenomyosis, cysts, and endometrial thickening. Imaging plays an important role in evaluating reproductive organs and detecting abnormalities.

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    This document summarizes male and female reproductive radiology. For males, it describes normal ultrasound findings and abnormalities like epididymitis, hydrocele, varicocele, and testicular torsion or carcinoma. For females, it outlines pelvic ultrasound and MRI to evaluate the uterus and ovaries, describing normal anatomy and abnormalities such as fibroids, adenomyosis, cysts, and endometrial thickening. Imaging plays an important role in evaluating reproductive organs and detecting abnormalities.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views7 pages

    Reproductive Radiology

    Uploaded by

    total copy
    This document summarizes male and female reproductive radiology. For males, it describes normal ultrasound findings and abnormalities like epididymitis, hydrocele, varicocele, and testicular torsion or carcinoma. For females, it outlines pelvic ultrasound and MRI to evaluate the uterus and ovaries, describing normal anatomy and abnormalities such as fibroids, adenomyosis, cysts, and endometrial thickening. Imaging plays an important role in evaluating reproductive organs and detecting abnormalities.

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    Male reproductive radiology:

    Imaging of the scrotum:

    • Best evaluated by ultrasound


    • Mostly performed for acute scrotal pain or palpable mass
    • Common scrotal abnorm alties;
    o Epididymitis and orchitis
    o Hydrocele
    o Varicocele
    o Torsion
    o Less common: testicular mass

    Normal ultrasound of testes: Homogenous echotexture with no focal lesions or surrounding fluid

    Normal Doppler ultrasound & waveform: Used to evaluate the blood flow

    • Venous wave – Approximately same amplitude


    • Arterial wave – Symmetric peak followed by down fall pattern

    Epididymitis and orchitis: Inflammation of the epididymis and/or testis

    Imaging findings of epididymitis:

    • Enlarged epididymis
    • Increased blood flow to the epididymis
    • Decreased echogenicity of the epididymis
    • May be focal or diNuse
    • Orchitis often secondary due to spread of infection

    Epididymo-orchitis:

    • Enlarged heterogenous epididymal head with increased blood flow


    • Doppler ultrasound of the testicle also demonstrates increasing flow
    Hydrocele: Scrotal fluid surrounding the testicle

    • Can be congenital
    • May be a result of;
    o Epididymitis
    o Torsion
    o Tumor
    o Trauma
    • Presents with enlarged scrotum

    Varicocele: Retrograde flow in the gonadal vein results in veins of the pampiniform plexus dilating to
    greater than 2-3mm.

    • It is the best seen with resting and Valsalva images of the scrotum
    o Valsalva demonstrates increased distention of the vessels due to the retrograde flow
    *It is most common cause of male infertility as there resultant increase in heat which destroys

    Testicular torsion: DO NOT MISS – timely detorsion can salvage the testicle

    • Imaging findings of testicular torsion


    o Overall decreased or absent blood flow to the testicle
    o First absence of venous flow, then loss of arterial flow
    o Enlarged, heterogenous hypoechoic testicle
    o DiNusely hypoechoic or small testicle indicates infarction

    Torsion and testicular carcinoma:

    • The image demonstrates a slightly heterogenous,


    hypoechoic testicle with no color or spectral on doppler
    evaluation
    • Next steps:
    o Call urology immediately for detorsion
    o There is a 80-100% chance of salvage if it is
    detorsed within 6 hours
    o There is no chanve of salvage if it has already been 24 hours
    o Normal ultrasound does not exclude early or partial torsion

    Testicular carcinoma:

    • Any solid mass within the testicle should raise suspicion for carcinoma
    • First line of imaging in patient presenting with a palpable mass is ultrasound
    • It presents itself as a heterogenous solid mass within the testicle with increased blood flow
    • Often metastasize to the paraaortic lymph nodes -> CT should always be next step for staging
    • Lung metastases are most common
    Female reproductive radiology:
    Uterine anatomy –

    Pelvic ultrasound:

    • Transabdominal
    o Performed with a full
    bladder which helps
    push the loops of bowel
    away
    o Provides a better
    window to evaluate the
    pelvis
    • Transvaginal
    o Provides better details of the endometrium and ovaries

    Uses of pelvic ultrasound:

    • Diagnostic tool in women presenting with pelvic symptoms such as vaginal bleeding or lower
    abdominal or pelvic pain
    • Routine surveillance and diagnostic tool in pregnant women

    Normal ultrasound anatomy of the uterus:

    Sonohysterogram – Procedure in which saline is injected into the uterus cavity which provides better
    visualization of the endometrium

    Uterine position:

    • Flexion – the position of the uterine body with respect to the cervix
    o Anteflexion or retroflexion
    • Version – The position of the cervix with respect to the vagina
    o Anteversion or retroversion

    Normal endometrium:

    • Premenopausal female
    o Thickness can vary based on her cycle
    o Can be as thick as 18-20 mm
    • Asymptomatic post-menopausal female
    o Thickness should be approximately 4mm or less
    o If thicker than 4mm, it is a concern for endometrial carcinoma due to no hormonal influx
    increasing the thickenss

    Normal ovaries – Best viewed under


    transvaginal exam

    • The uterus and ovaries are not well


    evaluated on CT therefore
    ultrasound is used as first line
    imaging

    Pelvic MRI:

    • Pelvic anatomy is seen very well on MRI


    • MRI is used as a problem solving tool for the pelvis

    Ovarian abnormalities:

    • Most common:
    o Cysts
    § Simple

    § Complex
    • Corpus luteal cyst
    o Functional ovarian cyst that forms after an egg expulsed from a
    follicle
    o Measures up to 3cm in size
    o Has thick rim with prominent peripheral flow on color doppler -
    “Ring of fire” appearance
    o Benign finding – no further follow up required
    • Hemorrhagic cyst
    o Echogenic cyst
    which resolves
    on follow-up
    imaging
    o Has reticular or
    lacy internal
    pattern
    o Ruptured
    hemorrhagic cyst can cause hemorrhagic free fluid to
    accumalte in the pelvis and abdomen
    • Dermoid cyst
    o Benign ovarian germ-cell tumor
    o Hyperechoic mass on ultrasound
    o May be heterogenous
    o Found to have fat on CT and or MRI
    o MRI: Bright on T1 and loses signal on T1 fat saturated images

    • Endometrioma
    o Endometrial tissue implants that repeatedly hemorrhage from
    hormonal stimulation
    o Named “Chocolate cyst” due to its appearance
    o Contains homogenous low-level internal echoes on ultrasound
    similar to that of hemorrhagic cyst
    o Classic MRI appearance
    § Bright on T1 and remains bright on T1 fat-saturated
    images with T2 shading
    § Loss of signal on T2 weighted images in a cyst that is
    bright on T1
    o Torsion
    § Twisting of the ovary and fallopian tube results in lack of blood flow to the ovary
    § Most commonly occurs with an associated ovarian mass acts as a “lead point”
    § Most commonly presents as severe unrelenting pelvic pain

    § Treatment of ovarian torsion


    • Open or laparoscopic surgery to untwist the adnexa is performed prior
    to infarction
    • If the ovary is infracted, then the treatment salpingo-oopheroectomy

    Ovarian tumors

    • Serous and mucinous cystadenoma and cystadenocarcinoma


    • Primarily cystic but contain irregular solid components
    • Best evaluated with CT or MRI

    Uterine abnormalities:

    Common uterine abnormalities include

    • Uterine fibroids (Leiomyoma)


    o Benign tumors of the smooth muscle cells of the uterus
    o Very common during reproductive years
    o Mostly asymptomatic but can cause pain, menorrhagia and infertility
    o Size determines symptomology
    o Imaging findings:
    § Hyperechoic mass
    § Possible calcifications
    § May have cystic
    components or fat
    o Location
    *Common not to discreetly identify multiple fibroids as they have the same echogenicity as the
    surrounding tissue. So a distorted heterogenous uterus indicates multiple fibroids

    o A fibroid that progressively enlarges in size or is greater than 8cm should be considered
    suspicious for a sarcoma and MRI should be performed to help diNerenciate – have
    potential to metastasize
    • Adenomyosis
    o Presence of heterotopic endometrial stroma within the myometrium
    o Clinical presentation often: dysmenorrhea (painful menstrual cycle) or menorrhagia
    (menstrual cycle lasting more than 7 days)
    o Image findings:
    § Enlarged uterus
    § Myometrial cystic spaces
    § Widened posterior uterine wall on ultrasound
    § Best visualized on ultrasound and MRI
    o Sagittal sonographic image shows a thickened myometrium
    with cystic space
    • Endometrial thickening

    o DiNicult to distinguish based on imaging alone


    o Sonohysterogram is helpful in diNerentiating focal from diNuse and in localizing a focal
    lesion
    o In post-menopausal women
    § Endometrial carcinoma until proven otherwise
    § Patient needs a hysterectomy with biopsy
    o Endometrial atrophy –
    § Occurs in postmenopausal women due to lack of hormonal stimulation
    § Endometrium is found to be less than 4mm
    § The most common cause of postmenopausal bleeding

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