Uterus

A free gallery of high-resolution, ultrasound, color doppler and 3D images

1) Dystrophic calcification of uterus:

These sonographic images of the uterus reveal a dense calcification involving the inner myometrium and endometrium. This 23 yr. old female had a history of curettage. The diagnosis- dystrophic calcification of the uterus. The cause is usually instrumentation or procedures like curettage. These have little clinical significance. However, bony remnants of any previously aborted fetus must be excluded (see reference below). Images courtesy of Dr. Jaydeep Gandhi, Mumbai, India.

Reference:

http://www3.interscience.wiley.com/cgi-bin/abstract/104555335/ABSTRACT (abstract)

2) Calcified fibroid:

Sonography of fibroid with calcification:

This middle aged female patient complained of pain in the suprapubic region. Ultrasound imaging revealed a small uterus with a calcific well-defined, intramural mass in the lower part of the body of uterus. There is clear acoustic shadowing posterior to the calcific lesion. These findings suggest a calcific fibroid of the uterus. Fibroids are often known to undergo calcificaiton in elderly females.

Reference: http://www.emedicine.com/radio/topic777.htm (free article)

3) Ultrasound image of Pedunculated fibroid:

Sonography of the uterus was done in this patient. Ultrasound image reveals a moderately large fibroid (7 x 5.3 cms.) connected to the fundus of the uterus by a thin stalk (peduncle). Ultrasound image courtesy of Dr. Ravi Kadasne, UAE. Machine used here is the Philips iu 22.

4) Fibroid in pregnancy:

Case-1: Fibroid in body of uterus:

These ultrasound and color Doppler images show a gravid uterus (with 3rd trimester fetus), and a solid, inhomogenous, poorly vascular mass in the anterior wall of the uterus, bulging into the uterine cavity. Note the hypoechoic areas within the mass suggesting possible degenerative changes. These images are diagnostic of a pregnancy with fibroid. Ultrasound images courtesy of Dr. Ravi Kadasne, UAE; he used the Philips iu 22 machine for these stunning pictures.

Case-2: Early pregnancy with fundic fibroid of uterus:

The 3 ultrasound pictures above show an early gestation sac (with a viable embryo), and a large fibroid in the fundus of the uterus. The mass (FIBR= fibroid), shows absence of degenerative changes or calcification despite its large size (almost 8 x 9 cms.). Power Doppler image of the uterus (image on top right) shows rim of vessels around the fibroid. Such early pregnancies with large fibroids have a high risk of abortions.

Case-3: Pregnancy with cervical fibroid:

This was a 19 week old pregnancy with the fetus seen to the left of the images. The ultrasound images show a large fibroid involving the lower uterine segment and cervix of the uterus. The mass measures 6 x 7 cms. approximately. Color Doppler image shows poor vascularity of the tumor. (FIBR= fibroid; fet= fetus; BL= bladder).

For more/ ultrasound video clips of this case see:

http://cochinblogs.blogspot.com/2010/05/fibroid-of-cervix-in-19-week-pregnancy.html

5) Types of fibroid:

A) Submucous fibroid:

This young adult female patient showed a large hyperechoic well defined, solid mass inside the body of uterus, in close relation to the endometrial cavity. Sonography of the uterus shows that the mass is possibly within the endomterial cavity. Power Doppler image (top-right) shows that there is a rim of vascularity around the mass. The mass measures more than 4 cms. in size. These ultrasound findings/ images suggest submucous fibroid of the uterus. The main differential diagnosis in this case is endometrial polyp. However, the larger size (polyps are usually less than 2 cms. in size) and lack of a single vascular pedicle (seen in polyps) suggest submucous fibroid. Images taken using a Toshiba Nemio-XG ultrasound system by Joe Antony, MD, India.

Reference: http://www.jultrasoundmed.org/cgi/reprint/26/7/941 (free article and images).

Case-2: Submucous fibroid: (3-D imaging):

Here are some interesting ultrasound images if a submucous fibroid using a new technique called Volume contrast imaging. This renders 2 D image sections of a volume image (3-D image) acquired of the part being studied (here the Uterus). (Images courtesy of Dr. PK Srivastava, India).

This technique appears to be an application of 3D/ 4D ultrasound. Observe how volume contrast ultrasound images of the uterus bring out the fine detail of the submucous fibroid and its margins. The image on lower right shows the 3D ultrasound appearance of the disease.

Case-3: Submucous fibroid:

This was a young adult female patient with a relatively large submucous fibroid bulging into the uterine cavity. Transabdominal ultrasound image (left) shows fluid within the uterine cavity bringing out the mass in contrast. This fluid was naturally present in the endometrial cavity possibly the result of endometritis. Color Doppler image (right) shows vascular pedicle supplying the fibroid. Images are courtesy of Ravi Kadasne, MD, UAE. The machine used here is the Toshiba Aplio.

B) Subserosal fibroid (also called Subserous fibroid):

Sonography of the pelvis done on this young adult female patient revealed a large, solid, non-calcific well defined mass located in the anterior wall of the body of uterus. The mass shows absence of central necrosis or infiltration of the bladder wall, though it compresses upon the urinary bladder. Since the mass lies just below the serosal layer of the uterus, these images suggest subserosal fibroid of the uterus. Such large, subserous fibroids of the uterus can cause pain and symptoms due to pressure effect on the urinary bladder, rectum, ureters etc. The Power Doppler image (bottom), shows stretching of the vessels around the rim of the fibroid.

Reference: http://bjr.birjournals.org/cgi/reprint/43/513/602

C) Isthmic fibroid:

This patient complained of pain in the lower abdomen and was suspected to have a disease of the ovaries or uterus. Sonography of the uterus shows a large, solid mass, 7.5 x 7.7 cms., in the lower part of the uterus, mainly involving the isthmic region (the junction between the body and cervix of the uterus). The mass shows typical features of in intramural fibroid of the uterus. Diagnosis: isthmic fibroid of the uterus. Isthmic fibroids can cause infertility and repeated abortions. Power Doppler image shows the vessels curving around the isthmic mass. Ultrasound images of isthmic fibroid taken using a Nemio-XG ultrasound system by Joe Antony, MD.

D) Broad ligament fibroid

Interligamentous fibroid or fibroid within broad ligament:

Sometimes a fibroid can grow laterally into the region between the two layers of the broad ligament, These ultrasound images show a solid mass to the right of the body of uterus. The mass is non calcific and shows no degenerative changes and appears to occupy the right broad ligament (arrows). This suggests a right broad ligament fibroid (also called interligamentous fibroid). Such fibroids can be difficult to remove surgically due to the vessels passing through the broad ligament.

Reference:1) http://www.healthsquare.com/fgwh/wh1ch07.htm (free article)

2) http://www.jkscience.org/archive/vol8a/BroadLigament.pdf (free article)

6) Pyometra:

This 70 yr. old patient presented with foul smelling vaginal discharge with fever. Sonography revealed a large collecion of fluid with echogenic debris within the endometrial cavity. Transvaginal ultrasound scan images reveal fluid within the fundus and body in the uterine cavity. These findings are diagnostic of pyometra. Color doppler imaging shows marginal increase in vascularity in the uterine walls. Images courtesy of Dr. Jaydeep Gandhi, Mumbai, India.

Reference: 1) Pyometra What is its clinical significance? (abstract- free)

2) Spontaneous Perforation of Pyometra (full text article- free)

Infections of the uterus:

Endometritis:

This female patient presented with symptoms of pelvic inflammatory disease (PID). Sonography of the uterus showed a bulky uterus with fluid distended (possibly purulent) endometrial cavity. The endometrium also appears thickened and hyperechoic. This ultrasound image is diagnostic of endometritis. The commonest of causes of endometritis are Chlamydial and/ or streptococcal infections. Untreated, it may progress to salpingitis or Pelvic abscess. Endometritis is a common disease during immediate post partum period. Ultrasound image is courtesy of Dr. Gunjan Puri, MD, India.

Reference: http://emedicine.medscape.com/article/254169-overview (free article and images).

7) Migrated IUCD:

This ultrasound image shows an IUCD (or Intra-uterine contraceptive device) that has migrated from the uterine cavity to pierce the posterior myometrial wall of the body of the uterus. Migration of the IUCD is a known complication of this device. Ultrasound image taken by Dr. Ravi Kadasne, UAE, using a Philips IU-22 ultrasound system.

Reference: http://www.ifpa.ie/contraception/iucd.html (free article)

8) Congenital anomalies of uterus:

Uterus didelphys or Didelphic uterus:

Sonography of the uterus shows 2 separate uteri, 2 separate cervices and separate vagina in this female patient. These ultrasound images are diagnostic of uterus didelphys or didelphic uterus. This is an extreme example of complete failure of fusion of the 2 halves of the uterus (Mullerian ducts) during the fetal stage.

These ultrasound images were taken by Dr. Ravi Kadasne, UAE, using a Philips IU 22 ultrasound machine.

9) Foreign body in cervix of uterus:

Rice grain in cervix in child:

This patient, a 3 yr. old female child had history of sitting and playing on a pile of rice grains. Following this incident, she complained of pain in the pelvis and perineum. Sonography of the pelvis in this child showed an echogenic lesion (echogenic focus) of 4 to 5mm. in the cervix of the uterus. Color Doppler images showed typical twinkling artifact around this lesion. There was intense posterior acoustic shadowing beyond this lesion. Given the history of the child, these ultrasound images suggest foreign body in the cervix, which in this case may be a rice grain. Sonographic images are courtesy of Dr. Vikas Shukla, MD, India.

Reference: http://www.gjms786.com/files/Case%20Vol-6-1.pdf

10) Uterine arterio-venous malformations:

AVM inside the uterus:

These transvaginal ultrasound and Color Doppler images of the uterus show inhomogenous hypoechoic lesions close to and within the endometrium of this female patient. Color Doppler, in addition, shows a tangle or chaotic pattern multiple dilated vessels in this region of the uterus, extending into its myometrium. Spectral Doppler shows high velocity flow pattern within these vessels, with low resistance (or high diastolic flow). This sonographic appearance is typical of AVM (arterio-venous malformation) of the uterus. This has to differentiated from GTD (gestational trophoblastic disease/ vesicular mole etc.) and retained products of conception. All images are courtesy of Dr. Dilraj Gandhi, MD, India. The machine used here was the GE Voluson.

Reference: 1) http://www.jultrasoundmed.org/cgi/reprint/25/11/1387 (free article and images)

2) http://radiographics.rsna.org/content/22/1/47.full.pdf+html (free article and images)

11) Adenomyosis of uterus:

Transvaginal ultrasound and Color Doppler images of the uterus in this patient show: irregular and asymmetric, diffuse enlargement of the uterus, poorly defined myometrial- endometrial interface (poorly defined endometrium), inhomogenous myometrium, streaky acoustic shadowing posterior to the uterus and irregular inhomogenous increase in vascularity of the myometrium (see Color Doppler image of uterus on right). There is also a poorly defined hypoechoic mass in the posterior myometrium. These ultrasound findings are suggestive of adenomyosis of the uterus. Sometimes hypoechoic/ anechoic cystic areas may also be seen in the myometrium in this disease (not seen here). The main differential diagnosis in this case is fibroid of the uterus. However, fibroids are well defined, more or less homogenous masses and do not produce streaky (dirty) shadows. Also, on transvaginal sonography fibroids are usually non-tender on probe pressure. Fibroids also usually have a hypoechoic halo or margin due to compressed vessels. Adenomyosis never contains calcific areas. Ultrasound images are courtesy of Dr. Latha Natarajan, India.

Reference: http://www.medscape.com/viewarticle/459772 (free article)

Case-2: Adenomyosis:

This transabdominal ultrasound image shows a large (bulky) uterus with a diffusely infiltrative, inhomogenous appearance of the myometrium with dirty, streaky shadowing posteriorly. The uterus shows a globular shape with the endometrium almost obscured. These features are typically seen in adenomyosis. However, both fibroids/ leiomyoma of the uterus can simultaneously be present with diffuse adenomyosis in this case. Ultrasound image courtesy of Vikas Shukla, MD, India.

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This page was last edited on: Friday May 28, 2010 04:48 PM

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