UTERUS WITH CERVIX WITH ADNEXA

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Histology of reproductive organs.

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Uterus with Cervix with Adnexa - Comprehensive Medical Test Guide

Section 1: Why is it done?
- This is a comprehensive ultrasound or MRI imaging examination of the female reproductive tract, including the uterus, cervix, fallopian tubes, and ovaries (adnexa). It provides detailed visualization of pelvic anatomy and identifies structural abnormalities or pathological conditions.
- Primary indications include:
- Evaluation of abnormal vaginal bleeding, pelvic pain, or abnormal pap smear results
- Assessment of infertility or recurrent miscarriage
- Detection and monitoring of fibroids, polyps, cysts, or masses
- Evaluation of endometriosis or adenomyosis
- Assessment of congenital uterine anomalies (bicornuate uterus, septate uterus)
- Staging and surveillance of gynecological malignancies
- Evaluation of pelvic mass or complex ovarian cysts
- Typical timing:
- Can be performed at any time; preferably performed 7-10 days after the first day of menstrual cycle when endometrium is thin for optimal visualization
Section 2: Normal Range
- Uterus:
- Size: 7-8 cm in length, 4-5 cm in width, 2-3 cm in thickness (may vary with age and parity)
- Shape: Normal pear-shaped, midline position
- Echogenicity: Homogeneous myometrium with no focal lesions
- Endometrium: Thickness 4-8 mm in follicular phase, 8-14 mm in luteal phase, <5 mm in postmenopausal women
- Cervix:
- Length: 2.5-3 cm (shorter in multiparous women)
- Appearance: Homogeneous, no masses or abnormal signal
- Adnexa (Ovaries and Fallopian Tubes):
- Ovarian volume: <12 cm³ in reproductive years, <8 cm³ in postmenopausal women
- Follicles: Up to 10 follicles (9 mm or less) considered normal
- Fallopian tubes: Thin-walled, <5 mm in diameter, patent on imaging
- No significant free fluid in pelvis (small amounts <100-200 mL acceptable)
- Normal Result Interpretation:
- Normal: All structures are within normal limits with appropriate morphology, size, and appearance; no masses, fibroids, cysts, or free fluid detected
Section 3: Interpretation
- Abnormal Findings and Clinical Significance:
- Uterine Fibroids (Leiomyomas):
- Well-defined solid masses within myometrium; can be submucosal, intramural, or subserosal
- May cause abnormal bleeding, pelvic pressure, or infertility
- Endometrial Polyps:
- Focal echogenic projections into uterine cavity; typically benign but may cause bleeding or subfertility
- Endometrial Hyperplasia/Thickening:
- Endometrium >8 mm in follicular phase or >14 mm in luteal phase; >5 mm in postmenopausal women warrants investigation
- Risk factors include obesity, tamoxifen use, unopposed estrogen; may progress to endometrial cancer
- Adenomyosis:
- Diffuse myometrial thickening and heterogeneous appearance; associated with severe dysmenorrhea and abnormal bleeding
- Congenital Uterine Anomalies:
- Septate uterus (incomplete septum), bicornuate uterus (two horns), unicornuate uterus, or didelphys; associated with infertility and miscarriage
- Ovarian Cysts:
- Simple cysts: Usually benign and follow-up ultrasound recommended based on size and characteristics
- Complex cysts: May indicate hemorrhage, infection, or malignancy; Ovarian-Adnexal Reporting and Data System (O-RADS) classification used for risk stratification
- Polycystic Ovary Syndrome (PCOS):
- Ovarian volume >10 cm³, >12 follicles in each ovary; associated with infertility, irregular menses, and metabolic dysfunction
- Tubal Pathology:
- Dilated tubes (hydrosalpinx), tubal occlusion, or tubo-ovarian complex; indicates infection, endometriosis, or infertility
- Endometriosis:
- Heterogeneous masses (especially in adenexae), cystic lesions with echogenic debris (chocolate cysts), or nodules; associated with pelvic pain and infertility
- Cervical Pathology:
- Cervical enlargement, heterogeneous echotexture, or masses; may indicate cervicitis, polyps, fibroids, or malignancy
- Malignancy:
- Irregular masses, heterogeneous appearance, invasion into adjacent structures, ascites, or lymphadenopathy; requires staging and further evaluation
- Factors Affecting Interpretation:
- Phase of menstrual cycle influences endometrial thickness and follicle appearance
- Body habitus and bowel gas may limit ultrasound visualization; MRI may be necessary
- Prior hysterectomy, cesarean section, or pelvic surgery alters anatomy
- Hormonal status (postmenopausal, on hormone therapy) affects organ size and appearance
Section 4: Associated Organs
- Primary Organ System:
- Female reproductive system (endocrine and genitourinary systems involved)
- Commonly Associated Medical Conditions:
- Menorrhagia and abnormal uterine bleeding (AUB) - often due to fibroids, polyps, or adenomyosis
- Primary and secondary infertility - associated with uterine anomalies, tubal obstruction, PCOS, endometriosis
- Recurrent miscarriage - linked to septate uterus, submucosal fibroids, endometrial abnormalities
- Dysmenorrhea and pelvic pain - associated with adenomyosis, endometriosis, fibroids
- Polycystic ovary syndrome (PCOS) - metabolic and endocrine disorder with infertility, irregular menses
- Endometriosis - chronic inflammatory condition causing pain and infertility
- Pelvic inflammatory disease (PID) - infection causing tubal damage and infertility
- Gynecological malignancies - endometrial, ovarian, and cervical cancers
- Diseases Diagnosed or Monitored:
- Uterine leiomyomas (fibroids)
- Endometrial polyps and hyperplasia
- Adenomyosis
- Müllerian duct anomalies (congenital uterine anomalies)
- Ovarian tumors and cysts
- Tubal pathology and hydrosalpinx
- Potential Complications or Risks from Abnormal Results:
- Hemorrhage: From uterine fibroids or endometrial lesions leading to severe anemia
- Infertility: From tubal occlusion, uterine anomalies, or severe endometriosis
- Miscarriage: From uterine abnormalities, fibroids, or endometrial pathology
- Infection: From PID leading to chronic pelvic inflammatory disease and potential sepsis
- Malignant transformation: Endometrial hyperplasia may progress to endometrial cancer; complex ovarian cysts may represent ovarian cancer
- Torsion: Ovarian cysts or masses may lead to ovarian torsion, a surgical emergency
- Ectopic pregnancy: From tubal damage or pathology
Section 5: Follow-up Tests
- Recommended Follow-up Testing Based on Findings:
- For Abnormal Endometrium (Thickening or Hyperplasia):
- Endometrial biopsy (definitive test for hyperplasia or malignancy)
- Saline infusion sonography (SIS) or hysteroscopy for detailed evaluation of endometrial cavity
- Repeat ultrasound 4-6 weeks or 3 months depending on findings
- For Ovarian Cysts:
- Simple cysts <3 cm: Routine follow-up, no imaging needed if completely simple
- Simple cysts 3-5 cm: Follow-up ultrasound at 4 weeks and 8 weeks in premenopausal women; 4 weeks and 12 weeks in postmenopausal women
- Simple cysts >5 cm: Follow-up ultrasound at 3, 6, and 12 months
- Complex cysts: MRI for characterization, consideration for CT or further imaging based on O-RADS classification; possible CA-125 blood test
- For Uterine Fibroids:
- MRI (if planning hysteroscopic resection or for better characterization and treatment planning)
- Follow-up ultrasound to monitor fibroid size if managing conservatively (6-12 months)
- Hysteroscopy for submucosal fibroids affecting fertility
- For Tubal Pathology:
- Hysterosalpingography (HSG) to evaluate tubal patency and morphology
- MRI with special techniques for detailed evaluation
- For Suspected Endometriosis:
- MRI (superior for evaluation of deep infiltrating endometriosis)
- Diagnostic laparoscopy for definitive diagnosis
- For Suspected Malignancy:
- MRI pelvis for staging
- CT chest/abdomen/pelvis for metastatic evaluation
- Endometrial biopsy or dilation and curettage (D&C)
- Tumor markers (CA-125, HE4, CEA) as appropriate
- For PCOS Diagnosis:
- Serum testosterone, free androgen index (FAI), DHEA-S
- LH/FSH ratio, fasting glucose and insulin levels
- Oral glucose tolerance test (OGTT) for metabolic screening
- For Congenital Uterine Anomalies:
- 3D ultrasound or MRI for definitive classification
- Renal ultrasound (to screen for associated renal anomalies)
- For Infertility Evaluation:
- Hysterosalpingography (HSG)
- Semen analysis (male factor evaluation)
- Hormonal assessment (FSH, LH, prolactin, thyroid function)
- Referral to reproductive endocrinology for assisted reproductive techniques (ART)
- Monitoring Frequency:
- Simple findings: Annual or as symptoms warrant
- Complex/concerning findings: 4-12 weeks based on imaging characteristics
- Malignancy: Per oncology protocols post-treatment
Section 6: Fasting Required?
- Is Fasting Required?
- No - Fasting is NOT required for pelvic ultrasound or MRI imaging of the uterus with cervix with adnexa.
- Patient Preparation Instructions:
- For Transabdominal Ultrasound:
- Full bladder recommended (drink 4-6 glasses of water 1 hour before exam and do not void)
- Wear comfortable, loose-fitting clothing that can be easily removed from abdomen
- Remove all jewelry, piercings, and metallic objects from abdomen and pelvis
- For Transvaginal Ultrasound:
- Empty bladder before exam for patient comfort
- Schedule when possible not during menstrual bleeding (although can be performed during menses)
- Avoid douching or tampon use for 24 hours before exam
- Refrain from intercourse 24 hours before exam if possible
- For MRI Imaging:
- No specific fasting required
- Remove all metallic objects including jewelry, hairpins, piercings, and electronic devices
- Inform technician of any implants, pacemakers, or metallic foreign bodies before exam
- Wear comfortable, loose clothing (may be asked to change into hospital gown)
- Medications:
- No medications need to be avoided or held prior to imaging
- Continue taking regular medications as prescribed
- Inform radiology staff of all medications and supplements, especially contrast allergies if relevant
- Other Important Considerations:
- Pregnancy status: Inform imaging staff if pregnant; ultrasound is safe in pregnancy, MRI generally avoided in first trimester unless clinically necessary
- Menstrual cycle timing: Ideally schedule 7-10 days after first day of period for optimal endometrial visualization
- Contraindications for MRI: Metallic implants, pacemakers, claustrophobia (discuss with physician for alternatives)
- Contact imaging facility in advance if any concerns or special needs

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