ultrasound of the reproductive system stacy fielding
TRANSCRIPT
Ultrasound of the Reproductive Ultrasound of the Reproductive System System
Stacy FieldingStacy Fielding
TechniqueTechnique
7.5-10mHz transducers7.5-10mHz transducers 5 mHz in mid to late term pregnancy, 5 mHz in mid to late term pregnancy,
pyometra, ovarian tumorspyometra, ovarian tumors Dorsal recumbency is routine Dorsal recumbency is routine
Larger animals standingLarger animals standing Full bladder enhances visualization of Full bladder enhances visualization of
uterusuterus Acoustic windowAcoustic window
OvariesOvaries
Near caudal pole of kidneyNear caudal pole of kidney 1.5cm x 0.7cm x 0.5cm1.5cm x 0.7cm x 0.5cm Homogenous parenchymaHomogenous parenchyma Cortex and medullaCortex and medulla
Hard to differentiateHard to differentiate Cortex contains folliclesCortex contains follicles
Ovaries-cont’dOvaries-cont’d
Anestrus/early proestrusAnestrus/early proestrus Small, oval to bean shapedSmall, oval to bean shaped Homogenous echogenicity (like renal Homogenous echogenicity (like renal
cortex)cortex) Follicles anechoic, become larger as Follicles anechoic, become larger as
ovulation approachesovulation approaches DiestrusDiestrus
CL/CH has multifocal anechoic to CL/CH has multifocal anechoic to hyperechoic areashyperechoic areas
Ovarian StructuresOvarian Structures
OvariesOvaries
Cystic OvariesCystic Ovaries AnechoicAnechoic Thin wallsThin walls Acoustic Acoustic
enhancementenhancement Solitary/multipleSolitary/multiple Unilateral/bilateralUnilateral/bilateral May see associated May see associated
pyometra or pyometra or hydrometrahydrometra
Ovarian NeoplasiaOvarian Neoplasia Several kindsSeveral kinds Mostly unilateralMostly unilateral Smooth or irregular Smooth or irregular
marginsmargins Variable Variable
appearanceappearance MET CHECK!MET CHECK!
Normal UterusNormal Uterus
Location: between urinary bladder and Location: between urinary bladder and descending colondescending colon
Various sizesVarious sizes Uterine horns: 10-14cm x 0.5-1.0cmUterine horns: 10-14cm x 0.5-1.0cm Uterine body: 1.4-3cm x 3cmUterine body: 1.4-3cm x 3cm Cervix: 1.5-2cm x 0.8cmCervix: 1.5-2cm x 0.8cm
Solid, homogenous, relatively hypoechoicSolid, homogenous, relatively hypoechoic May have thin hyperechoic borderMay have thin hyperechoic border Cannot differentiate layersCannot differentiate layers
Normal Uterus-cont’dNormal Uterus-cont’d
Uterine horns not Uterine horns not easily identifiedeasily identified Lost in mesenteric Lost in mesenteric
fat and small bowel fat and small bowel echoesechoes
Cervix Cervix Hyperechoic, linearHyperechoic, linear
PyometraPyometra
U/S is modality of choice for U/S is modality of choice for DxDx
Enlarged uterus & uterine Enlarged uterus & uterine hornshorns
Luminal contentsLuminal contents Homogenous, anechoicHomogenous, anechoic Echogenic, “swirling”Echogenic, “swirling”
May see varying wall May see varying wall thicknessthickness
Endometrium may contain Endometrium may contain anechoic focianechoic foci
Ddx: hydrometra, Ddx: hydrometra, mucometramucometra
Monitor response to therapy Monitor response to therapy
Uterine NeoplasiaUterine Neoplasia
AdenomasAdenomas LeiomyomasLeiomyomas LeiomyosarcomasLeiomyosarcomas Isoechoic to surrounding tissue, may Isoechoic to surrounding tissue, may
project into the lumenproject into the lumen
Pregnancy DiagnosisPregnancy Diagnosis 21-35 days after breeding21-35 days after breeding
Remember conception can occur several days afterwardRemember conception can occur several days afterward May be difficult to count fetusesMay be difficult to count fetuses
Radiography recommended late in gestation, following Radiography recommended late in gestation, following mineralizationmineralization
Earliest change = enlarging uterusEarliest change = enlarging uterus Non-specificNon-specific
Gestational sac (blastocyst)Gestational sac (blastocyst) First confirmatory signFirst confirmatory sign Anechoic, several mm diameterAnechoic, several mm diameter Thin, hyperechoic wallThin, hyperechoic wall 17-20 d17-20 d
18 day pregnancy18 day pregnancy
Pregnancy-cont’dPregnancy-cont’d
Embryo: 23-25 dEmbryo: 23-25 d Oblong, echogenic, several mm Oblong, echogenic, several mm
Yolk sac: 25-28 dYolk sac: 25-28 d U-shaped echogenic structure U-shaped echogenic structure Extends across gestational sacExtends across gestational sac
Zonary placenta: 27-30dZonary placenta: 27-30d Thin hyperechoic layer surrounding Thin hyperechoic layer surrounding
gestational sacgestational sac
Fetal ViabilityFetal Viability
Cardiac activityCardiac activity Day 23-25 post Day 23-25 post
LH surgeLH surge Fluttering echoesFluttering echoes
Fetal movementFetal movement Day 35Day 35
Fetal resorptionFetal resorption before day 25before day 25 Embryonic fluid Embryonic fluid
becomes becomes hypoechoichypoechoic
Echogenic particlesEchogenic particles AbortionAbortion
After day 35After day 35 Sonographic Sonographic
appearance appearance disappearsdisappears
Organogenesis Organogenesis (From Nyland & Mattoon)(From Nyland & Mattoon)
Fetal Fetal StructureStructure
Days Post Days Post LH SurgeLH Surge
Fetal Fetal orientationorientation
2828
Limb budsLimb buds 3535
SkeletonSkeleton 33-3933-39
Stomach, Stomach, bladderbladder
35-3935-39
LungsLungs 38-4238-42
Kidneys, eyesKidneys, eyes 39-4739-47
Cardiac Cardiac chamberschambers
4040
IntestinesIntestines 57-6357-63
ProstateProstate
Caudal to bladder, at level Caudal to bladder, at level of trigoneof trigone Ventral to rectumVentral to rectum
Normal appearance varies Normal appearance varies AgeAge Neuter statusNeuter status
Young to middle age intact Young to middle age intact male: male: homogenous, moderate homogenous, moderate
echogenicityechogenicity Smooth margins, Smooth margins,
hyperechoic rimhyperechoic rim Prostatic urethraProstatic urethra
Hypoechoic to anechoic Hypoechoic to anechoic round structure on midlineround structure on midline
Prostate DiseasesProstate Diseases
Benign Prostatic Benign Prostatic HyperplasiaHyperplasia Older intact dogsOlder intact dogs Symmetrical Symmetrical
enlargementenlargement May be up to 4 times May be up to 4 times
normalnormal Variable Variable
echogenicity and echogenicity and texturetexture
ProstatitisProstatitis Acute or chronicAcute or chronic Symmetrical or Symmetrical or
asymmetrical asymmetrical Heterogenous Heterogenous
appearanceappearance May see hypoechoic May see hypoechoic
areas (cyst or areas (cyst or abscess)abscess)
Mineralization, Mineralization, fibrosisfibrosis
Prostate DiseasesProstate Diseases
NeoplasiaNeoplasia Older neutered dogsOlder neutered dogs Enlarged Enlarged Irregular shapeIrregular shape Texture variesTexture varies
Hyperechoic foci with Hyperechoic foci with acoustic shadowing = acoustic shadowing = mineralizationmineralization
May see cyst-like May see cyst-like lesionslesions
Examine surrounding Examine surrounding structures!structures!
CystsCysts Developmental or Developmental or
congenitalcongenital Anechoic contentsAnechoic contents Thin hyperechoic wallThin hyperechoic wall Vary in size and #Vary in size and #
Paraprostatic CystsParaprostatic Cysts Muellerian duct Muellerian duct
remnant or extension of remnant or extension of lobelobe
Anechoic, fluid filled Anechoic, fluid filled May see swirliesMay see swirlies
Variable wall thicknessVariable wall thickness May see compartmentsMay see compartments
Prostatic CystProstatic Cyst
www.merckvetmanual.comwww.merckvetmanual.com
TestesTestes
Homogenous textureHomogenous texture Parietal and visceral tunics:Parietal and visceral tunics:
hyperechoichyperechoic Mediastinum testis:Mediastinum testis:
Echogenic linear structure on midlineEchogenic linear structure on midline Tail of the epididymisTail of the epididymis
Nearly anechoic Nearly anechoic Coarse echotextureCoarse echotexture
Testicular NeoplasiaTesticular Neoplasia
Interstitial, Sertoli cell, seminomaInterstitial, Sertoli cell, seminoma May all appear the sameMay all appear the same
Mixed appearance on U/SMixed appearance on U/S HemorrhageHemorrhage NecrosisNecrosis May obliterate mediastinum testis +/- May obliterate mediastinum testis +/-
epididymis epididymis
Testes-cont’dTestes-cont’d
Retained testesRetained testes Small sizeSmall size Caudal to kidneys Caudal to kidneys
to inguinal canalto inguinal canal Difficult to see on Difficult to see on
U/SU/S
OrchitisOrchitis Patchy, hypoechoic Patchy, hypoechoic
parenchymaparenchyma Hyperechoic if Hyperechoic if
chronicchronic Epididymal Epididymal
enlargementenlargement AbscessesAbscesses
Irregular shapedIrregular shaped Hypoechoic contentsHypoechoic contents
May look like May look like neoplasia!neoplasia!
