Transcript Ultrasound of the Reproductive System

Ultrasound of the Reproductive
System
Stacy Fielding
Technique
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7.5-10mHz transducers
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Dorsal recumbency is routine
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5 mHz in mid to late term pregnancy,
pyometra, ovarian tumors
Larger animals standing
Full bladder enhances visualization of
uterus
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Acoustic window
Ovaries
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Near caudal pole of kidney
1.5cm x 0.7cm x 0.5cm
Homogenous parenchyma
Cortex and medulla
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Hard to differentiate
Cortex contains follicles
Ovaries-cont’d
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Anestrus/early proestrus
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Small, oval to bean shaped
Homogenous echogenicity (like renal cortex)
Follicles anechoic, become larger as ovulation
approaches
Diestrus
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CL/CH has multifocal anechoic to hyperechoic
areas
Ovarian Structures
Ovaries
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Cystic Ovaries
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Anechoic
Thin walls
Acoustic enhancement
Solitary/multiple
Unilateral/bilateral
May see associated
pyometra or
hydrometra
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Ovarian Neoplasia
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Several kinds
Mostly unilateral
Smooth or irregular
margins
Variable appearance
MET CHECK!
Normal Uterus
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Location: between urinary bladder and
descending colon
Various sizes
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Uterine horns: 10-14cm x 0.5-1.0cm
Uterine body: 1.4-3cm x 3cm
Cervix: 1.5-2cm x 0.8cm
Solid, homogenous, relatively hypoechoic
May have thin hyperechoic border
Cannot differentiate layers
Normal Uterus-cont’d
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Uterine horns not
easily identified
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Lost in mesenteric fat
and small bowel
echoes
Cervix
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Hyperechoic, linear
Pyometra
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U/S is modality of choice for
Dx
Enlarged uterus & uterine
horns
Luminal contents
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Homogenous, anechoic
Echogenic, “swirling”
May see varying wall thickness
Endometrium may contain
anechoic foci
Ddx: hydrometra, mucometra
Monitor response to therapy
Uterine Neoplasia
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Adenomas
Leiomyomas
Leiomyosarcomas
Isoechoic to surrounding tissue, may
project into the lumen
Pregnancy Diagnosis
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21-35 days after breeding
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May be difficult to count fetuses
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Radiography recommended late in gestation, following
mineralization
Earliest change = enlarging uterus
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Remember conception can occur several days afterward
Non-specific
Gestational sac (blastocyst)
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First confirmatory sign
Anechoic, several mm diameter
Thin, hyperechoic wall
17-20 d
18 day pregnancy
Pregnancy-cont’d
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Embryo: 23-25 d
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Yolk sac: 25-28 d
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Oblong, echogenic, several mm
U-shaped echogenic structure
Extends across gestational sac
Zonary placenta: 27-30d
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Thin hyperechoic layer surrounding
gestational sac
Fetal Viability
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Cardiac activity
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Day 35
Fetal resorption
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Day 23-25 post LH
surge
Fluttering echoes
Fetal movement
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before day 25
Embryonic fluid
becomes hypoechoic
Echogenic particles
Abortion
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After day 35
Sonographic
appearance disappears
Organogenesis
Fetal
Structure
Days Post LH
Surge
Fetal orientation
28
Limb buds
35
Skeleton
33-39
Stomach, bladder
35-39
Lungs
38-42
Kidneys, eyes
39-47
Cardiac chambers
40
Intestines
57-63
(From Nyland & Mattoon)
Prostate
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Caudal to bladder, at level of
trigone
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Normal appearance varies
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Age
Neuter status
Young to middle age intact
male:
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Ventral to rectum
homogenous, moderate
echogenicity
Smooth margins, hyperechoic
rim
Prostatic urethra
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Hypoechoic to anechoic round
structure on midline
Prostate Diseases
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Benign Prostatic
Hyperplasia
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Older intact dogs
Symmetrical
enlargement
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May be up to 4 times
normal
Variable echogenicity
and texture
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Prostatitis
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Acute or chronic
Symmetrical or
asymmetrical
Heterogenous
appearance
May see hypoechoic
areas (cyst or abscess)
Mineralization, fibrosis
Prostate Diseases
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Neoplasia
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Older neutered dogs
Enlarged
Irregular shape
Texture varies
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Hyperechoic foci with
acoustic shadowing =
mineralization
May see cyst-like lesions
Examine surrounding
structures!
Cysts
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Developmental or
congenital
Anechoic contents
Thin hyperechoic wall
Vary in size and #
Paraprostatic Cysts
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Muellerian duct remnant or
extension of lobe
Anechoic, fluid filled
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May see swirlies
Variable wall thickness
May see compartments
Prostatic Cyst
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Testes
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Homogenous texture
Parietal and visceral tunics:
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Mediastinum testis:
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hyperechoic
Echogenic linear structure on midline
Tail of the epididymis
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Nearly anechoic
Coarse echotexture
Testicular Neoplasia
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Interstitial, Sertoli cell, seminoma
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May all appear the same
Mixed appearance on U/S
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Hemorrhage
Necrosis
May obliterate mediastinum testis +/epididymis
Testes-cont’d
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Retained testes
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Small size
Caudal to kidneys to
inguinal canal
Difficult to see on U/S
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Orchitis
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Patchy, hypoechoic
parenchyma
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Epididymal
enlargement
Abscesses
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Hyperechoic if chronic
Irregular shaped
Hypoechoic contents
May look like
neoplasia!