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41 Cards in this Set

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indications for HSG
infertility
recurrent SAB
post-op eval following tubal ligation or after tubal ligation reversal
pre-op eval for myomectomy
contraindications to hsg
active infx
+preg test
describe the basic anatomy of the uterus
cervix - most inferior to uterus
isthmus - portion of uterus immediately above cervix
body
fundus - uppermost portion
describe pathogenesis of congenital abnormalities of uterine shape
abn fusion of the mullerian ducts during 6-12 wks gestation
types of congenital anomalies of uterine shape
unicornuate - 1 mullerian duct doesn't form properly
bicornuate - the 2 mullerian ducts don't completely fuse; cleft in outer contour of fundus
septate uterus - when 2 ducts fuse, but incomplete resoprtion
arcuate - mild concavity of uterus at fundus
assoc anomalies if there is a congenital abn of uterine shape
genital and urinary systems develop from common ridge of mesoderm, so uterine and renal anomalies often co-exist
uterine folds
nml variant that is icaused by infolding of inner aspect of myometrium
appearance of multiple filling defects arising from 1 of the uterine walls
synechiae
intra-uterine adhesions that result from scarring, most commonly secondary to endometrial trauma of curettage or infx
uterine findings assoc with ashermans syndrome
multiple synechiae
endometriali polyps
focal overgrowths of endomeetrium
locations of leiomyoma

which are seen on hsg
subserosal
intramural
submucosal*
pathophys of adenomyosis
endometirum extens into myometrium
types of adenomyosis
diffuse
focal
appearance of adenomyosis on hsg
small diverticula extending into myometrium
dx of adenomyosis on mri
thichening of jxnl zone to 1cm+
4 portions of the fallopian tubes
interstitial (within uterine wall) - shortest segment
isthmic - longest portion
ampullary - widest portion, most distal
fimbriated portion - n/v on hsg
what is the best way to evaluate fallopian tubes
hsg
appearance of salpingitis isthmica nodosum
small outpouchings/diverticuala arising from isthmic portion of tube
appearance of salpingitis isthmica nodosum
small outpouchings/diverticuala arising from isthmic portion of tube
false positive to think that fallopian tube is occluded when it isn't
interstitial portion is encased by smooth muscle, and if the muscle of the uterus spasms the tube will look occluded.

give glucagon to relax muscle.
what is the best way to evaluate fallopian tubes
hsg
etiology of SIN
unknown
appearance of sequella of PID
tubal occlusion (of any portion)
if there is blockage in the ampulla --> hydrosalpinx
can also cause peritoneal/peritubal adhesions preventing free spillage of contrast
pathology of tubal polyps
ectopic endometrial tissue in interstitial portion of the tube
appearance of tubal polyps
smooth, rounded filling defects without dilatation
are tubal polyps assoc with infertility
no
pathophys of uterus didelphys
bilateral paramesonephric ducts fail to fuse at 9th week GA
didelphys uterus features
2 separate uterine cavities, each weigh nml anatomy, without communication with one another

75% have vaginal septum
conditions associated with didelphys uterus
if there i sobx of hemivagina, there can be retrograde menstrual flow --> endometriosis and pelvic adhesions
hematosalpinx can also occur, if severe
how to differentiate septated and bicornuate uterus
cannot tell on hsg, but on MRI, look at outer contour of uterus
septate uterus has a convex external contour, bicornuate uterus is heart shaped
most common mullein duct anomaly
septate uterus
pathophys of uterus didelphys
bilateral paramesonephric ducts fail to fuse at 9th week GA
didelphys uterus features
2 separate uterine cavities, each weigh nml anatomy, without communication with one another

75% have vaginal septum
conditions associated with didelphys uterus
if there i sobx of hemivagina, there can be retrograde menstrual flow --> endometriosis and pelvic adhesions
hematosalpinx can also occur, if severe
how to differentiate septated and bicornuate uterus
cannot tell on hsg, but on MRI, look at outer contour of uterus
septate uterus has a convex external contour, bicornuate uterus is heart shaped
most common mullein duct anomaly
septate uterus
2 types of uterine septum
complete - septum reaches from funds to os
incomplete - septum doesn't reach os
pathophys of transverse vaginal septum
near complete resorption of uterovaginal septum nmlly occurs at 7 mos, this doesn't happen if there is a septum
embryologic origins of vagina
upper 2/3 of vagina --> from mullerein ducts
lower 1/3 is technically part of the GU system
most severe mullerian duct anomaly
mullerian agenesis/hypoplasia (mayer-rokitansky-kuster-hauser syndrome) - presents w vaginal agensis
90% have cervical/uterine agenesis as well
MR appearance of unicornuate uterus
banana shaped uterus, endo is narrowed, tapered