CT TECHNIQUE CT OF ACUTE GYN EMERGENCIES UTERINE LEIOMYOMA ACUTE GYN EMERGENCIES ER US: TUBOTUBO-OVARIAN ABSCESS. y CT is the workhorse in the

Size: px
Start display at page:

Download "CT TECHNIQUE CT OF ACUTE GYN EMERGENCIES UTERINE LEIOMYOMA ACUTE GYN EMERGENCIES ER US: TUBOTUBO-OVARIAN ABSCESS. y CT is the workhorse in the"

Transcription

1 CHRISTINE O. MENIAS, MD Associate Professor of Radiolog CoCo-Director Emergenc Radiolog Mallinckrodt Institute of Radiolog St. Louis, MO CHRISTINE M. PETERSON, MD Assistant Professor of Radiolog Director of Bod CT Penn State Milton S. Hershe Medical Center Hershe, PA CT TECHNIQUE CT OF ACUTE GYN EMERGENCIES Ultrasound is usuall the imaging modalit of choice Results ma be equivocal Abnormalit ma be out of field of view Technicall difficult exam (obese patient) More than one organ sstem ma be affected Standard abdomen/pelvis protocol Oral and IV contrast helpful in delineating the uterus, ureters distinguish bowel loops from adnexal structures, pelvic fluid collections Patients often present with nonnonspecific complaints ie, Rule out appendicitis CT is the workhorse in the Ruptured hemorrhagic csts csts importance of IV contrast Delaed/pelographic phase imaging ma help delineate pelvic structures ER US: TUBOTUBO-OVARIAN ABSCESS ACUTE GYN EMERGENCIES Uterine Disorders Adnexal Disorders Infectious Processes PregnancPregnanc-Related Emergencies Affects >20% of women over 40 Most common uterine neoplasm rule out abdominal mass mass Growth is estrogen dependent More common and smptomatic at a ounger age in AfricanAfrican-American women Associated with obesit OVARIAN TORSION LEIOMYOMATOUS UTERUS PELVIC INFLAMMATORY DISEASE

2 CT Features: Usuall asmptomatic unless complicated b mass effect, torsion, degeneration Smptoms: menorrhagia, pelvic fullness, infertilit Large uterus Contour deformit Mixed attenuation mass with homogenous contrast enhancement FIBROID WITH MASS EFFECT Torsed pedicle, free fluid Infarcted left fibroid Patterns of Degeneration: Haline degeneration: degeneration: As fibroid outgrows its blood suppl, smooth muscle fibers appear to become acellular and homogenous Most common form of degeneration (unless degenerated) Popcorn or ringring-like dstrophic calcification (the most specific sign, but rare, ~10%) TORSED SUBSEROSAL FIBROID 30 cm mass with heterogeneous enhancement and calcification Cstic/Mxoid degeneration: degeneration: Progressive haline degeneration with tissue necrosis and liquefaction Ma present with acute pain

3 DEGENERATING LEIOMYOMA Carneous degeneration: degeneration: Hemorrhagic Ma cause hemoperitoneum if ruptured 42 o female with acute pelvic pain and vaginal bleeding o woman with acute abdominal pain and development of cstic low attenuation within fibroid SARCOMATOUS DEGENERATION Sarcomatous degeneration: Rare (<1%) Sudden growth of fibroid especiall in postpost-menopausal Beware the presence of gas if there has been no instrumentation, infection, or UFE Can Can t alwas differentiate from benign fibroid Large necrotic leiomosarcoma LEIOMYOSARCOMA ADNEXAL EMERGENCIES FUNCTIONAL OVARIAN CYSTS NonNon-infectious: Follicular Cst most common functional ovarian cst Ovarian csts prepre-ovulator follicle Hemorrhagic csts Ovarian torsion Ovarian hperstimulation Endometriosis usuall resolves 11-2 Ruptured hemorrhagic csts menstrual ccles

4 FUNCTIONAL OVARIAN CYSTS FUNCTIONAL OVARIAN CYSTS Corpus Luteum Cst Occur after ovulation Commonl hemorrhagic Theca Lutein Csts Bilateral, large csts resulting from clomiphene or excessive production of ß-HCG Resolve spontaneousl if no pregnanc occurs Infertilit patients treated with Clomid COMPLICATED OVARIAN CYSTS Csts ma bleed, rupture, torse Cst rupture ma cause life threatening hemorrhage Hemoperitoneum HEMORRHAGIC OVARIAN CYST CT Features: Features: Usuall <5cm diameter Cstic mass with areas of high attenuation Hematocrit level hemoperitoneum if ruptured Ma act and look like a ruptured ectopic pregnanc Ruptured hemorrhagic csts with hemoperitoneum HEMORRHAGIC OVARIAN CYST RUPTURED HEMORRHAGIC CYST US Features: Features: Cstic mass with septations Fish net net or lac lac appearance Low level internal echoes Hemoperitoneum if ruptured No internal vascularit Retracted clot ACTIVE EXTRAVASATION-HEMOPERITONEUM EXTRAVASATION--HEMOPERITONEUM

5 Adults Usuall involves both the ovar and fallopian tube associated with: lead mass long mesosalpinx prior surger Diagnosis and treatment often delaed NonNon-specific signs and smptoms Ma present as an acute abdomen Prompt diagnosis crucial in salvaging ovar and preventing complications Can result in hemorrhagic necrosis - progress to infection, infection, perforation, peritonitis, and death Venous compromise Æ ovarian engorgement Arterial occlusion Æ ovarian infarction Æ ma rupture Children Due to mobile mesosalpinx Torsed corpus luteal cst US Features US Features -Ovarian enlargement -Multiple immature peripheral follicles -No intraintra-ovarian venous flow -+/+/- lack of intraovarian arterial flow -Ovarian enlargement -Multiple immature peripheral follicles -No intraintra-ovarian venous flow -+/+/- lack of intraintra-ovarian arterial flow Enlarged left ovar with peripheral follicles No flow CT Features: Features: Enlarged midline ovar with peripheral follicles Ma be seen in children/adolescents 6 r old 8 r old Horn W, Menias C, Bennett G, ARRS 2006 CT Features: Features: Often unilateral (slight right side predominance) Fallopian tube thickening or twisted vascular pedicle Æ most specific finding Horn W, Menias C, Bennett G, ARRS 2006

6 CT Features : Amorphous adnexal mass representing torsed pedicle Ectopic location of adnexa Torsed ovarian teratoma terato more common in midline Horn W, Menias C, Bennett G, ARRS 2006 OVARIAN HYPERSTIMULATION SYNDROME Associated with fertilit drugs Theca lutein csts cause bilateral ovarian enlargement Increased capillar permeabilit Æ anasarca, ascites, hemoconcentration, pleural effusions, abdominal pain and distention OVARIAN HYPERSTIMULATION SYNDROME CT features: features: Bilaterall enlarged ovaries Enlarged peripheral follicles arranged in a spokespoke-wheel wheel pattern BILATERAL ENLARGED THECA LUTEIN CYSTS Ascites SPOKE WHEEL WHEEL OVARIAN HYPERSTIMULATION US features: features: SYNDROME Bilaterall enlarged ovaries Enlarged peripheral follicles SpokeSpoke-wheel wheel pattern Ascites ENDOMETRIOSIS Benign condition Endometrial tissue implanted outside the uterine cavit Found in ~50% of women <20 o with chronic pelvic pain Clinical smptoms: dsmenorrhea, dspareunia, infertilit, pelvic pelvic masses Ma present acutel

7 ENDOMETRIOSIS ENDOMETRIOSIS Endometrial implants can be seen in laparotom scars Can present acutel with focal pain at the site of scar 32 r old with focal cclical pelvic pain CT features: features: Implants are usuall ver small (<5mm) Æ not seen with imaging When visible b imaging, nonnon-specific Masses ma be both solid and cstic Usuall see multiple bilateral lesions Endometrioma Æ cstic mass (usuall ovarian) that results from repeated cclical hemorrhage into implant ( ( chocolate cst cst ) INFECTIOUS GYN EMERGENCIES PELVIC INFLAMMATORY DISEASE Dilated tubal lumen with edematous wall Pelvic Inflammator Disease TuboTubo-ovarian Abscess Dilated, fluidfluid-filled, enhancing tubetube-pid Enlarged, thick walled fallopian tubes PELVIC INFLAMMATORY DISEASE PELVIC INFLAMMATORY DISEASE Commonl due to Neisseria gonorrhoeae and Chlamdia trachomatis IUD users are prone to Actinomces israelii infection. Spectrum of disease ranging from salpingitis to TOA Ma cause fallopian tube scarring which predisposes to ectopic pregnanc / infertilit CT FEATURES Earl PID Pelvic edemaedema- infiltration of fat, thickened ureterosacral ligaments, obscured fascial planes EndometritisEndometritis- abnormal endometrial enhancement SalpingitisSalpingitis- thick, enhancing fallopian tubes OophoritisOophoritis- large, enhancing ovaries Peritoneal enhancement ENDOMETRITIS Advanced PID Large, thick walled, puspus-filled fallopian tubes Frank pelvic abscesses late in disease SALPINGITIS

8 PELVIC INFLAMMATORY DISEASE US FEATURES Thick, fluidfluid-filled fallopian tubes Large ovaries Frank pelvic abscesses late in disease FITZFITZ-HUGHHUGH-CURTIS SYNDROME Involvement of intraperitoneal structures b advanced PID b spread spread of infection via right paracolic gutter or lmphatics Intraperitoneal exudates cause violin string string adhesions between the liver capsule and peritoneum RUQ abdominal pain ma mimic cholecstitis or pelonephritis PREGNANCYPREGNANCY-RELATED EMERGENCIES FITZFITZ-HUGHHUGH-CURTIS SYNDROME Pelvic Hematoma PostPost-partum Abscess Ovarian Vein Thrombophlebitis Ectopic Pregnanc Uterine Perforation Retained Products of Conception HELLP Sndrome Menias et al, Emergenc Radiolog Jan 2007 Pelvic Hematoma BladderBladder-flap flap fluid collection Extraperitoneal/Pelvic hematoma s/p CC-section Post C-Section Abscess 21 ear old woman with pain and fever 1 month after CC-section bladderbladder-flap flap fluid collection

9 OVARIAN VEIN THROMBOPHLEBITIS Ma occur after pelvic trauma, infection, surger, chemotherap, or postpost-partum Occurs after 1:6001: births Right ovarian vein affected % of the time Thrombus ma extend into the renal vein and IVC Post CC-section abscess abscess note the CC-section defect OVARIAN VEIN THROMBOPHLEBITIS CT features: features: Enlarged ovarian vein Enhancing wall Low attenuation central thrombus Perivascular inflammation RUPTURED ECTOPIC PREGNANCY Occurs in >1/200 pregnancies Abnormal implantation almost alwas occurs in the fallopian tube (usuall ampullar segment). Pelvic pain, vaginal bleeding, adnexal mass Risk factors: factors: PID IUD Prior ectopic pregnanc Histor of tubal surger CT: Ectopic gestational sac, hemoperitoneum Courtes of A. Huete, MD, Santiago, Chile RUPTURED ECTOPIC PREGNANCY CT features: features: Adnexal mass with low attenuation center (gestational sac) Hemoperitoneum Enlarged fallopian tubes, ma contain blood Courtes of A. Huete, MD, Santiago, Chile RUPTURED ECTOPIC PREGNANCY

10 HEMORRHAGIC ADNEXA UTERINE RUPTURE RUPTURED ECTOPIC RUPTURED HEMORRHAGIC CYST UTERINE RUPTURE VBAC Risk is higher with a vertical scar versus a low transverse scar Increased risk with use of oxtocin, instrumentation, long labor Acute abdominal pain and lifelife-threatening hemorrhage Maternal mortalit 1%. Fetal mortalit ~30% UTERINE RUPTURE CT Features: Features: ExtraExtra-uterine fluid collections are abnormal after vaginal deliver Enlarged uterus with wall discontinuit Hemoperitoneum Menias et al, Emergenc Radiolog Jan 2007 RETAINED PRODUCTS OF CONCEPTION Large uterine defect/hemoperitoneum Æ16 hr induction with oxtocin RETAINED PRODUCTS OF CONCEPTION Placental or fetal tissue left behind after vaginal deliver or C-section Prolonged vaginal bleeding and infection Enlarged uterus with HIGH attenuation within endometrial canal Courtes of Howard Harvin, MD

11 RETAINED PRODUCTS OF CONCEPTION HELLP SYNDROME Hemolsis, Elevated Liver enzmes, Low Platelets Pre-eclampsia eclampsia DIC Ma have liver rupture Subcapsular liver hematoma Older, multiparous patients Maternal mortalit up to 25% Fetal mortalit as high as 60% Enlarged uterus with HIGH attenuation within endometrial canal HELLP SYNDROME HELLP SYNDROME 32 ear-old post-partum partum female with RUQ pain and hpotension Subcapsular hematoma Hemoperitoneum Acute hepatic infarction -- Note the postpartum uterus SUMMARY Several gnecologic conditions present with acute pelvic pain. Thus it is important for the radiologist to be familiar with the imaging features, so a timel diagnosis can be made Thanks to m former colleagues and friends Brett Gratz, MD Howard Harvin, MD

Gynecology Abnormal Physiology of the ovaries. Simple Cystic Masses

Gynecology Abnormal Physiology of the ovaries. Simple Cystic Masses Gynecology Abnormal Physiology of the ovaries (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Simple Cystic Masses ovary s function is to mature oocytes until

More information

Gynecology Abnormal Pelvic Anatomy and Physiology: Cervix. Cervix. Nabothian cysts. cervical polyps. leiomyomas. Cervical stenosis

Gynecology Abnormal Pelvic Anatomy and Physiology: Cervix. Cervix. Nabothian cysts. cervical polyps. leiomyomas. Cervical stenosis Gynecology Abnormal Pelvic Anatomy and Physiology: (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Cervix Nabothian cysts result from chronic cervicitis most

More information

ProSono Copyright 2006. Ovarian Pathology

ProSono Copyright 2006. Ovarian Pathology Ovarian Pathology Physiologic cysts: Functional cysts Pathology: A simple cyst is a sac containing fluid or semi-solid material. Physiologic cysts are generic types of hormonally active cysts that result

More information

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional OVARIAN CYSTS Follicular Cyst Ovarian cysts are fluid-filled sacs that form within or on the ovary. The majority of these cysts are functional meaning they usually form during a normal menstrual cycle.

More information

Pelvic Pain and In Vitro Fertilization

Pelvic Pain and In Vitro Fertilization September 2006 Pelvic Pain and In Vitro Fertilization Celeste Lopez, Harvard Medical School Year III September 18, 2006 Mrs. G 37yo with IVF oocyte retrieval the day before presentation to the ED Complains

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Ovarian Cysts

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Ovarian Cysts Ovarian Cysts WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The ovaries are two small organs located on either side of a woman s uterus. An ovarian cyst is a sac or pouch filled with fluid

More information

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002 Case Reports 21 August 2002 Ovarian Cyst Homoeopathy Clinic Check Yourself If you have any of the following symptoms call your doctor. Sense of fullness or pressure or a dull ache in the abdomen Pain during

More information

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system.

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Ovarian Cysts Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Most women have ovarian cysts sometime

More information

Laparoscopy and Hysteroscopy

Laparoscopy and Hysteroscopy AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Laparoscopy and Hysteroscopy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of

More information

Ovarian Torsion: Sonographic Evaluation

Ovarian Torsion: Sonographic Evaluation J Clin Ultrasound 17:327-332, June 1989 Ovarian Torsion: Sonographic Evaluation Mark A. Helvie, MD,* and Terry M. Silver, MDI Abstract: The sonographic and clinical findings of 13 patients with surgically

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis Endometriosis WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens

More information

Uterine fibroids (Leiomyoma)

Uterine fibroids (Leiomyoma) Uterine fibroids (Leiomyoma) What are uterine fibroids? Uterine fibroids are fairly common benign (not cancer) growths in the uterus. They occur in about 25 50% of all women. Many women who have fibroids

More information

Ovarian cysts Diagnosis and Management

Ovarian cysts Diagnosis and Management Ovarian cysts Diagnosis and Management Mr P K Athanasias MRCOG Consultant Gynaecologist St Anthony s Hospital pathanasias@gmail.com Introduction ovary is an ovum-producing reproductive organ located in

More information

Ultrasound in the First Trimester of Pregnancy. Elizabeth Lipson, HMS III

Ultrasound in the First Trimester of Pregnancy. Elizabeth Lipson, HMS III Ultrasound in the First Trimester of Pregnancy Elizabeth Lipson, HMS III First Trimester Sonography Localization of Gestational Sac Intrauterine vs. ectopic Identification of abnormalities Embryonic demise

More information

All you need to know about Endometriosis. Nordica Fertility Centre, Lagos, Asaba, Abuja

All you need to know about Endometriosis. Nordica Fertility Centre, Lagos, Asaba, Abuja All you need to know about Endometriosis October, 2015 About The Author Nordica Lagos Fertility Centre is one of Nigeria's leading centres for world class Assisted Reproductive Services, with comfort centres

More information

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Abnormal Uterine Bleeding WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has

More information

MRI of the Uterus BENIGN. Jeffrey C. Weinreb, M.D. FACR jeffrey.weinreb@yale.edu Yale University School of Medicine

MRI of the Uterus BENIGN. Jeffrey C. Weinreb, M.D. FACR jeffrey.weinreb@yale.edu Yale University School of Medicine MRI of the Uterus BENIGN Jeffrey C. Weinreb, M.D. FACR jeffrey.weinreb@yale.edu Yale University School of Medicine Normal Anatomy M Junctional JZ Zone EE Junctional Zone is the inner layer or the myometrium

More information

Women s Health Laparoscopy Information for patients

Women s Health Laparoscopy Information for patients Women s Health Laparoscopy Information for patients This leaflet is for women who have been advised to have a laparoscopy. It outlines the common reasons doctors recommend this operation, what will happen

More information

Benign Ovarian Masses

Benign Ovarian Masses Benign Ovarian Masses Anthony Hanbidge Learning Objectives Describe technique for assessment of ovarian masses Explain importance of transvaginal scan List the common benign masses Specify distinguishing

More information

Abnormal Uterine Bleeding FAQ Sheet

Abnormal Uterine Bleeding FAQ Sheet Abnormal Uterine Bleeding FAQ Sheet What is abnormal uterine bleeding? Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period. Bleeding that occurs between

More information

Ovarian Cystectomy / Oophorectomy

Ovarian Cystectomy / Oophorectomy Cystectomy and Ovarian Cysts Ovarian cysts are sacs filled with fluids or pockets located on or in an ovary. In some cases, these cysts need to be removed surgically. Types of Cysts Ovarian cysts are quite

More information

Glossary. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty.

Glossary. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty. Glossary amenorrhea - absence or cessation of menstrual periods. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty. A amenorrhea, secondary - due to some physical

More information

Endometriosis: An Overview

Endometriosis: An Overview Endometriosis: An Overview www.bcwomens.ca Welcome to the BC Women s Centre for Pelvic Pain and Endometriosis. This handout will give you some basic information about endometriosis. It will also explain

More information

良 性 附 屬 器 腫 瘤 簡 介. Benign adnexal mass

良 性 附 屬 器 腫 瘤 簡 介. Benign adnexal mass 良 性 附 屬 器 腫 瘤 簡 介 Benign adnexal mass Prepubertal Age Group Adolescent Age Group Reproductive Age Group Postmenopausal Age Group Prepubertal Age Group Differential Diagnosis Diagnosis and Management Prepubertal

More information

Abdominal CT scan findings in Acute Appendicitis

Abdominal CT scan findings in Acute Appendicitis Abdominal CT scan findings in Acute Appendicitis Pathophysiology of acute appendicitis. Acute appendicitis occurs when the lumen is obstructed, leading to fluid accumulation, luminal distention, inflammation

More information

Uterine Fibroids. More than half of all women have fibroids. They are a common, benign, uterine growth.

Uterine Fibroids. More than half of all women have fibroids. They are a common, benign, uterine growth. Uterine Fibroids More than half of all women have fibroids. They are a common, benign, uterine growth. Fibroids are not a disease. Much like the genetic blueprint that determines the color of your eyes

More information

1 st Trimester OB Ultrasound

1 st Trimester OB Ultrasound Indications/Goals: 1 st Trimester OB Ultrasound Geoffrey E. Hayden, MD Director of Emergency Ultrasonography Vanderbilt Emergency Medicine Primary objective is to identify an intrauterine pregnancy Secondary

More information

The following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test".

The following chapter is called Follow-ups with a Positive or a Negative Pregnancy Test. Slide 1 Welcome to chapter 7. The following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test". The author is Professor Pasquale Patrizio. Slide 2 This chapter has the following

More information

Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women

Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women Carolyn S. Dupuis, Young H. Kim Department of Radiology, UMass Memorial Medical Center, University of Massachusetts

More information

From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors

From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors Uterine Fibroid Tumors A woman s fibroisis condition usually associated with estrogen dominance. Uterine

More information

AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE UTERINE FIBROIDS A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient

More information

Anatomy and Physiology of Human Reproduction. Module 10a

Anatomy and Physiology of Human Reproduction. Module 10a This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle

Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle Eun Ju Lee, MD, Hyuck Chan Kwon, MD, Hee Jae Joo, MD, Jung Ho Suh, MD, Arthur C. Fleischer, MD The purpose

More information

POSTMENOPAUSAL ASSESS AND WHAT TO DO

POSTMENOPAUSAL ASSESS AND WHAT TO DO POSTMENOPAUSAL OVARIAN CYSTS:HOW TO ASSESS AND WHAT TO DO Steven R. Goldstein, MD Professor of Obstetrics and Gynecology Director of Gynecologic Ultrasound Co-Director, Bone Densitometry New York University

More information

LAPAROSCOPIC OVARIAN CYSTECTOMY

LAPAROSCOPIC OVARIAN CYSTECTOMY LAPAROSCOPIC OVARIAN CYSTECTOMY Information Leaflet Your Health. Our Priority. Page 2 of 5 About this information This leaflet is for you if you have a cyst on one or both ovaries and are considering surgery.

More information

Abigail R. Proffer, M.D. October 4, 2013

Abigail R. Proffer, M.D. October 4, 2013 Abigail R. Proffer, M.D. October 4, 2013 Topics Human Papillomavirus (HPV) Vaccines Pap smears Colposcopy Contraception Polycystic Ovary Syndrome (PCOS) Can I get pregnant? Miscarriage Abnormal Uterine

More information

Sonographic Spectrum of Hemorrhagic Ovarian Cysts

Sonographic Spectrum of Hemorrhagic Ovarian Cysts Image Presentation Sonographic Spectrum of Hemorrhagic Ovarian Cysts Kiran A. Jain, MD Objective. To present the spectrum of sonographic findings associated with hemorrhagic ovarian cysts. Methods. Experience

More information

טופס הסכמה לטיפולי הפרייה חוץ גופית

טופס הסכמה לטיפולי הפרייה חוץ גופית טופס הסכמה לטיפולי הפרייה חוץ גופית CONSENT FORM: IN-VITRO FERTILIZATION (IVF) 1. General In-vitro fertilization is performed in cases of impaired fertility, which may be caused by the following: Obstruction

More information

Artificial insemination with donor sperm

Artificial insemination with donor sperm Artificial insemination with donor sperm Ref. 123 / 2009 Reproductive Medicine Unit Servicio de Medicina de la Reproducción Gran Vía Carlos III 71-75 08028 Barcelona Tel. (+34) 93 227 47 00 Fax. (+34)

More information

Abdomen X-Ray (AXR) Collimation is ideally from diaphragms to lower border of the symphysis pubis and the lateral skin margins.

Abdomen X-Ray (AXR) Collimation is ideally from diaphragms to lower border of the symphysis pubis and the lateral skin margins. Abdomen X-Ray (AXR) Collimation is ideally from diaphragms to lower border of the symphysis pubis and the lateral skin margins. LMP of child-bearing age female patients should be checked. 1. Acute abdomen

More information

Acute pelvic inflammatory disease: tests and treatment

Acute pelvic inflammatory disease: tests and treatment Acute pelvic inflammatory disease: tests and treatment Information for you Information for you Published August 2010 Published in August 2010 (next review date: 2014) Acute What is pelvic inflammatory

More information

Hysterectomy. The time to take care of yourself

Hysterectomy. The time to take care of yourself Hysterectomy The time to take care of yourself The time to take care of yourself Women spend a lot of time taking care of others spouses, children, parents. We often overlook our own needs. But when our

More information

1. AMOUNT OF FSH PRESENT

1. AMOUNT OF FSH PRESENT The Menstrual Cycle Name Date Period PRE-LAB 1. Write down three facts you know about the menstrual cycle. A. B. C. FOLLICULAR PHASE Within the ovaries are located many egg cells. Each egg is enclosed

More information

Diseases of peritoneum Lect. Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32

Diseases of peritoneum Lect. Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32 Diseases of peritoneum Lect Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32 Describe the etiology, pathogenesis and types of peritonitis Define ascites and

More information

Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S.

Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S. Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S. Gynecologic Oncology, Surgery and Endoscopy 4370 Alpine Road Portola Valley, CA 94028-7523 Phone: (650)-851-6669 FAX: (650) 851-9747 Regarding Ovarian Cancer,

More information

About the Uterus. Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include:

About the Uterus. Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include: Hysterectomy removal of the uterus is a way of treating problems that affect the uterus. Many conditions can be cured with hysterectomy. Because it is major surgery, your doctor may suggest trying other

More information

Uterine Fibroid Symptoms, Diagnosis and Treatment

Uterine Fibroid Symptoms, Diagnosis and Treatment Fibroids and IR Uterine Fibroid Symptoms, Diagnosis and Treatment Interventional radiologists use MRIs to determine if fibroids can be embolised, detect alternate causes for the symptoms and rule out misdiagnosis,

More information

COMPLICATIONS OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM

COMPLICATIONS OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM COMPLICATIONS OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM PREGNANCY WITH ABORTIVE OUTCOME (630 639.9) 630 HYDATIDIFORM MOLE 631 OTHER ABNORMAL PRODUCT OF CONCEPTION 632 MISSED ABORTION 633 ECTOPIC PREGNANCY

More information

Saint Mary s Hospital. Ovarian Cysts. Information For Patients

Saint Mary s Hospital. Ovarian Cysts. Information For Patients Saint Mary s Hospital Ovarian Cysts Information For Patients 2 Contents Welcome 4 What are ovarian cysts? 4 How common are ovarian cysts? 6 Ovarian cysts and fertility 6 What are the symptoms of ovarian

More information

Heavy periods (menstrual bleeding)

Heavy periods (menstrual bleeding) Heavy periods (menstrual bleeding) This information sheet has been given to you to help answer some of the questions you may have about heavy periods and the treatments that are available. This leaflet

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Birth Control Pills

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Birth Control Pills Birth Control Pills WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Birth control pills (also called oral contraceptives or "the pill") are used by millions of women in the United States to

More information

How To Bill For A Pregnancy

How To Bill For A Pregnancy Maternity Billing The Maternity Period - For billing purposes, the obstetrical period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum

More information

SUBSEROSAL FIBROIDS TREATMENT

SUBSEROSAL FIBROIDS TREATMENT INTRODUCTION Uterine fibroids, also known as leiomyomas, are the most common pelvic mass found in women. Fibroids are benign tumors that arise from the uterine muscular tissue (myometrium). They occur

More information

Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015

Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015 Benign liver diseases Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015 1 Agenda Benign focal liver lesions Fatty liver disease

More information

K Raja/N Varol FPA 2013. FPA Sydney August 31 2013

K Raja/N Varol FPA 2013. FPA Sydney August 31 2013 FPA Sydney August 31 2013 Ms wilson 32 year old woman Presents with worsening, heavy menstrual and intermenstrual bleeding and pain for 6 months. Ms Wilson What is the differential diagnosis What are the

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

What are the differences between fibroid and ovarian cyst?

What are the differences between fibroid and ovarian cyst? DR LEE KEEN WHYE MBBS (Singapore), FRCOG (U.K), FAMS (Singapore) Consultant Obstetrician & Gynaecologist Advisor, Endometriosis Association, Singapore KW Lee Clinic & Surgery For Women No. 6 Napier Road,

More information

Menstruation and the Menstrual Cycle

Menstruation and the Menstrual Cycle Menstruation and the Menstrual Cycle Q: What is menstruation? A: Menstruation is a woman s monthly bleeding, also called a period. When you menstruate, your body is shedding the lining of the uterus (womb).

More information

Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites

Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites Article ID: WMC002405 ISSN 2046-1690 Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites Corresponding Author: Dr. Tanweer Karim, MS, Department of Surgery, MGM Medical College, Navimumbai,

More information

Cornual ruptured pregnancy with placenta increta CORNUAL RUPTURED PREGNANCY WITH PLACENTA INCRETA A RARE CASE

Cornual ruptured pregnancy with placenta increta CORNUAL RUPTURED PREGNANCY WITH PLACENTA INCRETA A RARE CASE 142 CORNUAL RUPTURED PREGNANCY WITH PLACENTA INCRETA A RARE CASE Agarwal NR 1, Rani A 1 *, Batra S 1 1. Department of Obststetrics and Gynaecology, Institute of Medical Sciences, Banares Hindu Univarsity.

More information

Treating heavy menstrual bleeding caused by fibroids or polyps

Treating heavy menstrual bleeding caused by fibroids or polyps Treating heavy menstrual bleeding caused by fibroids or polyps With today s medical advances the outlook for successful treatment of fibroids and polyps has never been better. You don t have to live with

More information

Once a woman has had a hysterectomy, she will no longer have menstrual periods and cannot have a child. She no longer needs to use contraception.

Once a woman has had a hysterectomy, she will no longer have menstrual periods and cannot have a child. She no longer needs to use contraception. Hysterectomy Summary Hysterectomy is the surgical removal of the womb (uterus), with or without the cervix. Hysterectomy is used to treat a number of conditions, including heavy or painful periods, fibroids

More information

In Vitro Fertilization

In Vitro Fertilization Patient Education In Vitro Fertilization What to expect This handout describes how to prepare for and what to expect when you have in vitro fertilization. It provides written information about this process,

More information

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts Pediatr Radiol DOI 10.1007/s00247-006-0240-0 ORIGINAL ARTICLE Ada Kessler. Hagith Nagar. Moshe Graif. Liat Ben-Sira. Elka Miller. Drora Fisher. Irith Hadas-Halperin Percutaneous drainage as the treatment

More information

DISEASES OF THE GENITOURINARY SYSTEM

DISEASES OF THE GENITOURINARY SYSTEM DISEASES OF THE GENITOURINARY SYSTEM NEPHRITIS, NEPHROTIC SYNDROME ANS NEPHROSIS (580 589.9) 580 ACUTE GLOMERULONEPHRITIS 580.0 WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS 580.4 WITH LESION OF RAPIDLY

More information

The Menstrual Cycle, Hormones and Fertility Treatment

The Menstrual Cycle, Hormones and Fertility Treatment The Menstrual Cycle, Hormones and Fertility Treatment How many of us understand how our monthly cycle works? Every 28 days (or thereabouts), between the ages of around 13 and 51, a woman will release a

More information

Why would you need a hysterectomy?

Why would you need a hysterectomy? Why would you need a hysterectomy? Removal of the uterus is performed to prevent, alleviate, or treat pain, pressure, bleeding, or cancer. Each reason is described in detail in the following pages. Benign

More information

Ectopic Pregnancy. A Guide for Patients PATIENT INFORMATION SERIES

Ectopic Pregnancy. A Guide for Patients PATIENT INFORMATION SERIES Ectopic Pregnancy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications

More information

Diagnosis Codes for Pregnancy and Complications of Pregnancy

Diagnosis Codes for Pregnancy and Complications of Pregnancy This list is for informational purposes only and is not a binding or definitive list of covered conditions. It is not a guarantee of coverage; coverage depends on the available benefits and eligibility

More information

OVARIAN CYSTS AND TORSION

OVARIAN CYSTS AND TORSION Key: = important notes = reference to torsion = reference to malignancy OVARIAN CYSTS AND TORSION Epidemiology:

More information

A Guide to Hysteroscopy. Patient Education

A Guide to Hysteroscopy. Patient Education A Guide to Hysteroscopy Patient Education QUESTIONS AND ANSWERS ABOUT HYSTEROSCOPY Your doctor has recommended that you have a procedure called a hysteroscopy. Naturally, you may have questions about

More information

2014 OB/GYN Surgery Medicare Reimbursement Coding Guide

2014 OB/GYN Surgery Medicare Reimbursement Coding Guide 2014 OB/GYN Surgery Medicare Reimbursement Coding Guide Effective January 1, 2014 Medicare National Average Rates and Allowables (Not Adjusted For Geography) CPT * HCPCS Code 58150 58152 58180 58200 58210

More information

THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER

THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER Partner #1 Last Name (Surname): Partner #1 First Name: Partner #1 Last 5 Digits

More information

Summa Health System. A Woman s Guide to Hysterectomy

Summa Health System. A Woman s Guide to Hysterectomy Summa Health System A Woman s Guide to Hysterectomy Hysterectomy A hysterectomy is a surgical procedure to remove a woman s uterus (womb). The uterus is the organ which shelters and nourishes a baby during

More information

LIPPES LOOP TRADEMARK. your intrauterine contraceptive

LIPPES LOOP TRADEMARK. your intrauterine contraceptive LIPPES LOOP TRADEMARK your intrauterine contraceptive LIPPES LOOP Patient Information This brochure provides information on the use of In trauterine Contraceptive Devices (lud s). There are other birth

More information

BERGEN COMMUNITY COLLEGE DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Division of Health Professions DMS 213 SYLLABUS

BERGEN COMMUNITY COLLEGE DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Division of Health Professions DMS 213 SYLLABUS BERGEN COMMUNITY COLLEGE DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Division of Health Professions DMS 213 SYLLABUS Course Title: DMS 213 - Abdominal Sonography 2 2 lec. 3 lab. 3 credits (5 hours) Required

More information

Endometriosis Obstetrics & Gynaecology Women and Children s Group

Endometriosis Obstetrics & Gynaecology Women and Children s Group Endometriosis Obstetrics & Gynaecology Women and Children s Group This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that

More information

OB/GYN. Clerkship Learning Objectives. Office for Clinical Affairs Department of OB/GYN (515) 271-1629 (515) 271-1421 FAX (515) 271-1727

OB/GYN. Clerkship Learning Objectives. Office for Clinical Affairs Department of OB/GYN (515) 271-1629 (515) 271-1421 FAX (515) 271-1727 OB/GYN Clerkship Learning Objectives Rebecca Shaw, MD, FACOG Office for Clinical Affairs Department of OB/GYN (515) 271-1629 (515) 271-1421 FAX (515) 271-1727 General Description Required Rotation This

More information

Variations in Appearance of Endometriomas

Variations in Appearance of Endometriomas CME rticle Variations in ppearance of Endometriomas Elizabeth sch,, Deborah Levine, MD Objective. ecause of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation

More information

FEMALE ANATOMY. the Functions of the Female Organs

FEMALE ANATOMY. the Functions of the Female Organs FEMALE ANATOMY the Functions of the Female Organs An educational video for every woman who is told she needs pelvic surgery, including exploratory surgery or removal of the uterus, fallopian tubes, or

More information

, hereby agree to a form of treatment known

, hereby agree to a form of treatment known Patient Consent for Therapy Human In Vitro Fertilization and Embryo Transfer This is to certify that I, as In Vitro Fertilization and Embryo Transfer., hereby agree to a form of treatment known I have

More information

CHLAMYDIA SCREENING IN WOMEN

CHLAMYDIA SCREENING IN WOMEN CHLAMYDIA SCREENING IN WOMEN APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE What screening should be done? NCQA ACCEPTED CODES DOCUMENTATION

More information

The Menstrual Cycle. Model 1: Ovarian Cycle follicular cells

The Menstrual Cycle. Model 1: Ovarian Cycle follicular cells The Menstrual Cycle REVIEW questions to complete before starting this POGIL activity 1. Gonads produce both gametes and sex steroid hormones. For the female, name the: A. gonads ovaries B. gametes oocyte/ovum/egg

More information

Cardiovascular diseases. pathology

Cardiovascular diseases. pathology Cardiovascular diseases pathology Atherosclerosis Vascular diseases A disease that results in arterial wall thickens as a result of build- up of fatty materials such cholesterol, resulting in acute and

More information

School of Diagnostic Medical Sonography

School of Diagnostic Medical Sonography Semester 1 Orientation - 101 This class is an introduction to sonography which includes a basic anatomy review, introduction to sonographic scanning techniques and physical principles. This curriculum

More information

GLOSSARY. A Abstinence: having no vaginal, anal, or oral sex. It is the only method that is 100% effective in preventing pregnancy and STI s.

GLOSSARY. A Abstinence: having no vaginal, anal, or oral sex. It is the only method that is 100% effective in preventing pregnancy and STI s. WOMEN S HEALTH GLOSSARY We encourage you to learn the meanings behind these words for your personal health and to fully understand the words being used during your appointments at the Falcon Health Center.

More information

The Acute Abdomen. Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital

The Acute Abdomen. Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital The Acute Abdomen Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital Causes of the Acute Abdomen Hemorrhage in the GI tract Blood vessel GU tract Perforation of the GI tract Ulcer Infection

More information

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions What are the Colon and Rectum? The colon and rectum together make up the large intestine. After

More information

Uterus myomatosus. 10-May-15. Clinical presentation. Incidence. Causes? 3 out of 4 women. Growth rate vary. Most common solid pelvic tumor in women

Uterus myomatosus. 10-May-15. Clinical presentation. Incidence. Causes? 3 out of 4 women. Growth rate vary. Most common solid pelvic tumor in women Uterus myomatosus A.J. Henriquez March 14, 2015 Uterus myomatosus Definition, incidence, clinical presentation and diagnosis. New FIGO classification for uterine leiomyomas Brief description on treatment

More information

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy Case Series Summary of Cases: USER EXPERIENCE The ABThera OA NPT system was found by surgeons to be a convenient and effective

More information

Understanding Endometriosis - Information Pack

Understanding Endometriosis - Information Pack What is endometriosis? Endometriosis (pronounced en- doh mee tree oh sis) is the name given to the condition where cells like the ones in the lining of the womb (uterus) are found elsewhere in the body.

More information

Hysterosalpingography

Hysterosalpingography Scan for mobile link. Hysterosalpingography Hysterosalpingography uses a real-time form of x-ray called fluoroscopy to examine the uterus and fallopian tubes of a woman who is having difficulty becoming

More information

Egg Donation Process, Risks, Consent and Agreement

Egg Donation Process, Risks, Consent and Agreement THE CENTER FOR HUMAN REPRODUCTION (CHR) 21 East 69 th Street, New York, NY 10021 T: 212-994-4400; F: 212-994-4499 Egg Donation Process, Risks, Consent and Agreement Updated on: 10/8/2014 Date: Egg Donor

More information

Basics of infertility Student Lecture Dr. A. Vilos, MD, FRCSC, Ass. Professor Department of OB/Gyn, REI Division Western University

Basics of infertility Student Lecture Dr. A. Vilos, MD, FRCSC, Ass. Professor Department of OB/Gyn, REI Division Western University Definitions Basics of infertility Student Lecture Dr. A. Vilos, MD, FRCSC, Ass. Professor Department of OB/Gyn, REI Division Western University Infertility One year of frequent unprotected intercourse

More information

This is Jaydess. Patient Information. What is Jaydess? How does Jaydess work?

This is Jaydess. Patient Information. What is Jaydess? How does Jaydess work? , Patient Information This is Jaydess We hope that this brochure will answer your questions and concerns about Jaydess. What is Jaydess? Jaydess is an intrauterine device consisting of a hormone capsule

More information