Ebook Blueprints Radiology (2nd edition): Part 2
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Ebook Blueprints Radiology (2nd edition): Part 2
ChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2nected to the uterus by the broad ligament. The fimbriae of the fallopian tubes wrap around the ovaries but are also open to the peritoneal cavity. An ovum released from an ovarian follicle remains free in the peritoneal cavity for a brief time before being swept into the fallopian tube by the fimbr Ebook Blueprints Radiology (2nd edition): Part 2iae (Figure 7-1).■I ECTOPIC PREGNANCYAnatomyEctopic pregnancy results when implantation occurs outside the uterine cavity. By far the most common siteEbook Blueprints Radiology (2nd edition): Part 2
is the fallopian tube, but other possible locations include the ovary, the abdomen, or the endocervix.Figure 7-1 • Normal anatomy of the female reproChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2de.EpidemiologyEctopic pregnancy can occur at any reproductive age. Rates of ectopic pregnancy have increased over the years, and a higher prevalence of sexually transmitted diseases (STDs) has been postulated as a cause.PathogenesisEctopic pregnancy is usually the result of previously damaged fallo Ebook Blueprints Radiology (2nd edition): Part 2pian tubes. When normal fertilization occurs in the distal portion of the tube, the conceptus traverses the proximal tube to implant within the uterinEbook Blueprints Radiology (2nd edition): Part 2
e cavity. Any structural or functional distortion of the fallopian tube prevents tins normal process. One of the most common reasons is infection fromChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2o structurally altered uterine tubes.Clinical ManifestationsHistoryThe most common complaint is intermittent or constant lower abdominal pain and, less commonly, bleeding. Many women are not aware of being pregnant at the time of presentation.Physical ExaminationAbdominal tenderness with palpation i Ebook Blueprints Radiology (2nd edition): Part 2s usually localized to the right or left lower quadrants, but some72 • Plueprintộ Radiologypatients have diffuse pain. Bimanual examination may help tEbook Blueprints Radiology (2nd edition): Part 2
o localize this sign further, but care should be excercised to avoid iatrogenic rupture of the ectopic pregnancy. Inability to elicit pain does not exChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2transvaginal ultrasound are the standard for diagnosis. The principles involved in making the diagnosis rely on the levels of beta-hCG being well correlated with a certain gestational age. At a beta-HCG level of 1500 miu per milliliter, called the discriminator}' zone, a normal intrauterine pregnanc Ebook Blueprints Radiology (2nd edition): Part 2y should be visualized by ultrasound. Absence of an intrauterine pregnancy meets the criterion for the label of abnormal pregnancy'.Radiologic FindingEbook Blueprints Radiology (2nd edition): Part 2
sMany times an extrauterine mass can be visualized by ultrasound, further supporting the clinical diagnosis. The usual finding is a mass located betweChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2ll using a fully distended urinary bladder as a window for imaging) should also be performed. The mass has the characteristics of an early gestation with an echolucent(dark) center surrounded by echogenic tissue. If the ectopic pregnancy is advanced, a fetal pole and even cardiac motion can be detec Ebook Blueprints Radiology (2nd edition): Part 2ted. Sometimes the outline of the fallopian tube can be appreciated sonographically.Evaluation of the uterus may be normal, but a pseudogestational saEbook Blueprints Radiology (2nd edition): Part 2
c (blood in the endometrial cavity) can sometimes be identified. If the conceptus implants within one of the cornua of the uterus (the portion of the ChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2 to hemoperitoneum resulting from rupture of the tube.KEY POINTS1Ectopic pregnancy is a challenging clinical diagnosis, and the increase in number of cases is attributed to a rise in STDs.2Ultrasound is the imaging study of choice for aiding in diagnosing an ectopic pregnancy.3A normal transvaginal Ebook Blueprints Radiology (2nd edition): Part 2ultrasound does not exclude an ectopic pregnancy. Efforts should be made to locate the ectopic pregnancy by transabdominal ultrasound.4A complex (echoEbook Blueprints Radiology (2nd edition): Part 2
genic and echolucent component) adnexal mass, the absence of a normal intrauterine pregnancy, and correlation with a positive beta-hCG is 95% diagnostChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are conn Ebook Blueprints Radiology (2nd edition): Part 2topic pregnancy (ECT) adjacent to the left ovary (LO). The uterus (UT) contained no gestational sac.(Courtesy of University of Southern California Medical Center, Los Angeles, CA.)■ OVARIAN TORSIONEtiology Ebook Blueprints Radiology (2nd edition): Part 2ChapterObstetric and Gynecologic Imaging■ GENERAL ANATOMYThe adnexal structures, including the ovaries, fallopian tubes, and ovarian vessels, are connGọi ngay
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