Sonographic sign of ovulation is:
A- Development of solid echoes within Graafian follicle prior to 18mm size.
B- "Ring" structure within uterine fundus.
C- Absence of free fluid in pouch of Douglas.
D- Hyperechoic thickened endometrium... ***
E- Continuous cystic enlargement of follicle.
Functional pathology of the endometrium:
It is secondary to an oestro-progestational imbalance (hormone-dependent pathology).
Endometrial atrophy:
Virtually physiological postmenopausal, it shows a state of hypoestrogenemia and can sometimes be the cause of metrorrhagia that can not be attached to this cause after elimination of any other etiology especially tumoral.
During periods of genital activity, it may be secondary to:
+ Iatrogen:
- Agonists or antagonists of LH-RH,
- pure progestins,
- Mini-dose pill,
- Danazol.
+ Pathological:
- hypothalamic-pituitary amenorrhea,
- Ovarian insufficiency.
On the ultrasound plan:
- Cavity line surrounded by a thin hypoechoic band whose thickness is less than 5 mm,
- After a long period of hypoestrogenesis, uterine involution and increased resistance of the uterine arteries.
Endometrial hypertrophy:
- Demonstrates hormonal imbalance, endogenous absolute or relative hyperoestrogeny (obesity, PCO, anovulation) or iatrogenic (estrogenic treatment, Tamoxifen),
- Ultrasound does not allow to determine the benign or malignant character of the hypertrophy. Histological verification is most often essential,
- The ultrasound measurement of the thickness of the endometrium must be done in the first part of the cycle. Hypertrophy is evident from 10 mm thick,
- In case of diffuse thickening, the endometrium exceeds 15 mm, sometimes globular appearance but respecting a clear junction with the myometrium,
- The cavitary line is often less visible but remains central which eliminates a large mucous polyp.
We distinguish:
- simple hypertrophy: mucosa globally homogeneous and hyperechoic. In hysterosonography, the banks are regular,
- mucosal folds: can be quite large, hyperechoic and localized,
polypoid hypertrophy: associated mucous polyps,
- glandulo-cystic hypertrophy: hypertrophy associated with cystic images (cystic dilation of the glandular channels). These images often have a benign character.
Differential diagnosis of these cysts:
+ uterine adenomyosis lesions,
+ cystic atrophy of the endometrium,
+ vitelline vesicle of a beginning pregnancy,
+ molar pregnancy.
- Interest of hysterosonography in case of diagnostic doubt: Thick mucosa with corrugated edge surrounding an empty cavity.
Discordant endometrium:
The thickness of the endometrium does not correspond with the period of the cycle or the gynecological context.
Hyperechoic aspect of secretory type in follicular period:
- early ovulation,
- dysplastic endometrium,
- endometritis,
- mucous polyp,
- LUF syndrome,
secretory transformation linked to an inductive treatment of ovulation.
Hypoechoic aspect in secretory period:
- late ovulation,
- date error.
A- Development of solid echoes within Graafian follicle prior to 18mm size.
B- "Ring" structure within uterine fundus.
C- Absence of free fluid in pouch of Douglas.
D- Hyperechoic thickened endometrium... ***
E- Continuous cystic enlargement of follicle.
Functional pathology of the endometrium:
It is secondary to an oestro-progestational imbalance (hormone-dependent pathology).
Endometrial atrophy:
Virtually physiological postmenopausal, it shows a state of hypoestrogenemia and can sometimes be the cause of metrorrhagia that can not be attached to this cause after elimination of any other etiology especially tumoral.
During periods of genital activity, it may be secondary to:
+ Iatrogen:
- Agonists or antagonists of LH-RH,
- pure progestins,
- Mini-dose pill,
- Danazol.
+ Pathological:
- hypothalamic-pituitary amenorrhea,
- Ovarian insufficiency.
On the ultrasound plan:
- Cavity line surrounded by a thin hypoechoic band whose thickness is less than 5 mm,
- After a long period of hypoestrogenesis, uterine involution and increased resistance of the uterine arteries.
Endometrial hypertrophy:
- Demonstrates hormonal imbalance, endogenous absolute or relative hyperoestrogeny (obesity, PCO, anovulation) or iatrogenic (estrogenic treatment, Tamoxifen),
- Ultrasound does not allow to determine the benign or malignant character of the hypertrophy. Histological verification is most often essential,
- The ultrasound measurement of the thickness of the endometrium must be done in the first part of the cycle. Hypertrophy is evident from 10 mm thick,
- In case of diffuse thickening, the endometrium exceeds 15 mm, sometimes globular appearance but respecting a clear junction with the myometrium,
- The cavitary line is often less visible but remains central which eliminates a large mucous polyp.
We distinguish:
- simple hypertrophy: mucosa globally homogeneous and hyperechoic. In hysterosonography, the banks are regular,
- mucosal folds: can be quite large, hyperechoic and localized,
polypoid hypertrophy: associated mucous polyps,
- glandulo-cystic hypertrophy: hypertrophy associated with cystic images (cystic dilation of the glandular channels). These images often have a benign character.
Differential diagnosis of these cysts:
+ uterine adenomyosis lesions,
+ cystic atrophy of the endometrium,
+ vitelline vesicle of a beginning pregnancy,
+ molar pregnancy.
- Interest of hysterosonography in case of diagnostic doubt: Thick mucosa with corrugated edge surrounding an empty cavity.
Discordant endometrium:
The thickness of the endometrium does not correspond with the period of the cycle or the gynecological context.
Hyperechoic aspect of secretory type in follicular period:
- early ovulation,
- dysplastic endometrium,
- endometritis,
- mucous polyp,
- LUF syndrome,
secretory transformation linked to an inductive treatment of ovulation.
Hypoechoic aspect in secretory period:
- late ovulation,
- date error.
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Radiology MCQ