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As noted above, the knowledge of sagittal, coronal, and axial choroid plexus papilloma usg attention to maximizing image detail; and correlation with the patient's history and physical examination should offer a comprehensive evaluation of the gynecologic patient.

Ovarian Malignancy

In all probability, the role of gynecologic scanning will continue to expand. The correlation of palpable pelvic findings with visual images of tissue texture should enhance the diagnostic acumen hpv negatif et dysplasie the clinical gynecologist.

It is incumbent on all clinicians, however, to continue to strive to delineate the appropriate utilization of this modality and to limit its use to those clinical situations when the cost-benefit ratio clearly warrants its use. In closing, a word should be mentioned regarding training and experience of the gynecologic ultrasonographer.

At this time, no specific guidelines exist regarding the educational experience necessary for assurance of competence in gynecologic imaging. Prerequisites to the utilization of this technique are a thorough knowledge of gynecologic physiology and pathology; the ability to access or obtain a thorough gynecologic history and physical examination; and experience in acquisition, display, and documentation of ultrasonographic choroid plexus papilloma usg. Obviously, attention to continuing education through periodicals and postgraduate courses is necessary if the physician is to stay abreast of this rapidly expanding field.

For this reason, it is more difficult to scan posthysterectomy patients than those with a uterus in situ. The uterus should be readily seen in the midplane of the pelvis and normally exhibits an echo density that is clearly distinguishable from surrounding pelvic viscera Fig. The endometrial echo has a variable density, depending on water content and cellular density, that fluctuates with the hormonal status of the patient Fig.

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The changes noted in endometrial ultrasonographic appearance have been characterized. Progressive echogenicity of the functional zone compactum and spongiosum occurs with completion of the preovulatory phase and during the secretory phase. Retrodisplacement of the uterus usually produces a less clearly defined image on transabdominal scanners, but does not interfere with uterine delineation significantly using the transvaginal approach.

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The uterine cervix is visible and may be measured with a great degree of accuracy, especially with the transvaginal technique. It should be remembered that with the transvaginal approach, the cervix may not be seen if the scanning tip is placed in either the anterior or posterior fornix. For this reason, careful scanning during insertion and removal of the scanning transducer is advisable. The bladder should be partially distended before attempting transabdominal scanning.

Ovarian Malignancy – Routine Investigations & Specific Investigations

Caution must be used to differentiate a full urinary bladder from a unilocular, anechoic- type ovarian cyst that may lie anterior to the uterus. If any question regarding this possibility exists, a postvoid scan is advisable for definitive evaluation. Excessive filling of the urinary bladder displaces the uterus so posteriorly that not only does the patient experience undue discomfort, but adequate imaging is difficult.

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Conversely, in the interpretation of transabdominal 4 images with inadequate bladder filling, significant posterior uterine wall or fundal pathology may be missed. The appropriate amount of urine in the bladder for optimal visualization varies from patient to patient.

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During insonation of unilocular cystic structures, a proximal artifact may occur as a result of near-field sensitivity, or of the "gain setting" producing near-field reverberation artifact. To the uninitiated, this echo may appear to represent intracystic echo-dense areas.

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Variation of the sensitivity gain setting of the equipment allows these areas to be differentiated from more significant findings. On either side of the urinary bladder in the anterolateral pelvic area are the iliopsoas muscles.

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These areas should not be confused with pathologic pelvic masses Fig. Frequently the urethra and the urethrovesical junction can be visualized. Transvaginal or perineal introital scanning will enhance this imaging of these structures. VAGINA The vagina appears as a collapsed tubular structure lying inferior to the urinary bladder and distal to the uterine cervix by transabdominal scanning.

Transvaginal ultrasonography does not delineate choroid plexus papilloma usg vagina as well as the transabdominal or perineal introital approach.

Anomalies of vaginal development are discussed later in this text. Occasionally, with overdistention of the urinary bladder, urine may accumulate in the vagina Fig.

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Likewise, the presence of tampons or menstrual blood may be discerned. ADNEXA The adnexa include the ovaries, fallopian tubes, blood vessels, choroid plexus papilloma usg ligaments, and peritoneal folds of the lateral pelvis.

The main choroid plexus papilloma usg that are recognizable with ultrasonography include the ovary, fallopian tube, and vascular anatomy. The position of the ovary is somewhat variable, depending on the length of the infundibulopelvic ligament, the presence or absence of adhesions, and other anatomic abnormalities that may displace the ovary. Usually, the ovaries lie in a lateral position to the uterus and are identifiable by scanning in transverse or longitudinal planes lateral to the uterine corpus.

Identification of the internal iliac vessels with transvaginal ultrasonography is helpful in identifying the appropriate location of the ovary, but manipulation of the scanning transducer to bring out the full extent of the ovarian echo is frequently necessary.

During transvaginal scanning, the manipulation should be performed slowly, and patient cooperation is helpful.


In the absence of pelvic adhesive disease, the ovary is noted to move in response to transducer manipulation. With the availability of high-resolution ultrasonography, the ability to monitor follicular development exists.

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Follicles are clearly visible in the majority of ovaries choroid plexus papilloma usg women of reproductive age, and appear as echo- sparse, well-circumscribed areas within the ovarian stroma, varying between 5 and 20 mm in diameter Fig.

Ultrasonographic follicular monitoring has become an integral aspect of ovulation induction protocols by allowing correlation of serum estradiol levels with follicular diameter during gonadotropin stimulation.

A follicular diameter of 18 to 22 mm is characteristic of a periovulatory follicle. Velocity waveform analysis reveals increasing diastolic velocity in the periovulatory and luteal phase Fig. The fallopian tube is difficult to visualize in the normal state.

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Frequently, in cases of abnormal tubal morphology, such as after the development of a hydrosalpinx or neoplasm, the tube may choroid plexus papilloma usg more clearly defined. Transvaginal ultrasonography results in a higher frequency of tubal visualization.

A hydrosalpinx is typically a convoluted, anechoic tubular structure Fig. Frequently the tube and ovary form a complex, echo- dense, adnexal mass in cases of adhesive inflammatory disease of the pelvis or a neoplastic process.

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