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Mani Montazemi, RDMS Female Anatomy
Normal Anatomy of the
Female Pelvis
Mani Montazemi, RDMS
Clinical Instructor – Imaging Manager
Baylor College of Medicine
Division of Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
Texas Children’s Hospital, Pavilion for Women
Houston Texas Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
• Longitudinal, vertical planes • Divide the body into left & right
Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
A
P
H F
Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
2
Mani Montazemi, RDMS Female Anatomy
Sagittal Scan
Mani Montazemi, RDMS Female Anatomy
Transverse Scan
• Horizontal planes • Divide the body into superior & inferior
Mani Montazemi, RDMS Female Anatomy
Transverse Scan
Mani Montazemi, RDMS Female Anatomy
Transverse Scan
A
P
R L
Mani Montazemi, RDMS Female Anatomy
Transverse Scan
Mani Montazemi, RDMS Female Anatomy
Transabdominal Transverse
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Mani Montazemi, RDMS Female Anatomy
Uterus
Located in Pelvis Between Bladder & Rectum
Mani Montazemi, RDMS Female Anatomy
Vagina
• Lies between the urinary bladder & rectum
• The vaginal canal is indicated by the bright line separating the anterior and posterior walls
BL
Mani Montazemi, RDMS Female Anatomy
Vagina
• The vaginal canal helps to identify the midline view of the uterus
• Helps to distinguish lateral displacement of the uterus
Mani Montazemi, RDMS Female Anatomy
Vagina
Mani Montazemi, RDMS Female Anatomy
Vagina
• If the hymen is imperforated at menarche the vagina will fill with blood, forming a hematocolpos
Mani Montazemi, RDMS Female Anatomy
Vagina
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Mani Montazemi, RDMS Female Anatomy
Vagina
Mani Montazemi, RDMS Female Anatomy
Vagina
Mani Montazemi, RDMS Female Anatomy
Cervix
• Lower cylindrical neck of the uterus which projects into vagina
Mani Montazemi, RDMS Female Anatomy
Cervix
• Internal os – Junction of the uterine
cavity and endocervical canal
• External os – Junction of the
endocervical canal and vagina
Mani Montazemi, RDMS Female Anatomy
Cervix
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Mani Montazemi, RDMS Female Anatomy
Uterus
• Cervix • Body • Fundus
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Mani Montazemi, RDMS Female Anatomy
Layers of Uterus
1. Endometrium – Inner layer which varies in thickness & echo pattern
with stage of the menstrual cycle
2. Myometrium – Thick, middle muscle layer
3. Serosa – Thin outer layer
Mani Montazemi, RDMS Female Anatomy
Endometrium
Mani Montazemi, RDMS Female Anatomy
Myometrium inner muscular layer – low echogenicity
Mani Montazemi, RDMS Female Anatomy
Myometrium middle muscular layer – moderate echogenicity
Mani Montazemi, RDMS Female Anatomy
Myometrium arcuate arterial & venous plexus
Mani Montazemi, RDMS Female Anatomy
Serosa
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Mani Montazemi, RDMS Female Anatomy
Endometrium central stripe
Mani Montazemi, RDMS Female Anatomy
Endometrium
inner functional layer
Mani Montazemi, RDMS Female Anatomy
Endometrium
outer basal layer
Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
• Thickness and echotexture depend upon hormonal status
Mani Montazemi, RDMS Female Anatomy
Normal Endometrial Cycle Early Proliferative Phase
Linear Echogenic Mani Montazemi, RDMS Female Anatomy
Normal Endometrial Cycle Late Proliferative Phase
Multilayered
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Mani Montazemi, RDMS Female Anatomy
Normal Endometrial Cycle Secretory Phase
Homogeneously Echogenic Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
• Under influence of estrogen & progestrone
• The glandular epithelium secrets a glycogen rich fluid
• Spiral arteries become tortuous
Mani Montazemi, RDMS Female Anatomy
Premenopausal Endometrium
Basal layer remains thin & hyperechoic throughout the menstrual cycle
Mani Montazemi, RDMS Female Anatomy
Intermenstrual Bleeding When should the ultrasound examination be performed?
Mani Montazemi, RDMS Female Anatomy
Intermenstrual Bleeding When should the ultrasound examination be performed?
• Immediate Postmenstrual Phase
• The endometrium is
thin in this phase & small endometrial
lesions are least likely
to be obscured
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Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
“Early Proliferation Phase” 1-3 mm
Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
“Late Proliferation Phase” 4-7 mm
Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
“Secretory Phase” 8-15mm
Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
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Mani Montazemi, RDMS Female Anatomy
Endometrial Thickness
Postmenopausal < 5mm
Mani Montazemi, RDMS Female Anatomy
How to Measure?
SAG TRV
Mani Montazemi, RDMS Female Anatomy
How to Measure?
Mani Montazemi, RDMS Female Anatomy
SAG
TRV
Mani Montazemi, RDMS Female Anatomy
Endometrial Measurements
Mani Montazemi, RDMS Female Anatomy
Endometrial Measurements
• Not included in measurement: – fluid/debris in canal – subendometrial halo
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Mani Montazemi, RDMS Female Anatomy
Endometrial Measurements
* *
* *
Mani Montazemi, RDMS Female Anatomy
Endometrial Measurements
Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
Mani Montazemi, RDMS Female Anatomy
Endometrial Appearance
*
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Mani Montazemi, RDMS Female Anatomy
Postmenopausal Endometrium
• The endometrium becomes atrophic
• Appears as a thin echogenic line 4-5 mm thick
Mani Montazemi, RDMS Female Anatomy
Postmenopausal Endometrium
• Small amounts are common, especially in women receiving HRT
• Aids in evaluating the appearance of the endometrium
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Mani Montazemi, RDMS Female Anatomy
Uterine Positions
• Anteverted – Tilted forward
• Anteflexed – Forward fold between the
body & the cervix
• Retroverted – Tilted backwards
• Retroflexed – Flexed between body &
cervix
Mani Montazemi, RDMS Female Anatomy
Uterine Positions
Tilted Forward
Mani Montazemi, RDMS Female Anatomy
Uterine Positions
Tilted backwards
Mani Montazemi, RDMS Female Anatomy
Uterine Positions
Mani Montazemi, RDMS Female Anatomy
Uterine Size
• Childhood – 2/3 cervix, 1/3 body &
fundus
• Puberty – 1 to 1 ratio between
cervix body & fundus • Adult
– 1/3 cervix, 2/3 body & fundus
Mani Montazemi, RDMS Female Anatomy
Uterine Shape
• Childhood – Cylindrical shape – Corpus shrinks due to withdrawal of
maternal hormones – Will not grow until ovaries produce
hormones • Puberty
– Assumes the pear shape • Menopausal
– Shrinks & regress to prepubertal state
12
Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
8Length x 5Width x 3AP cm
Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
SAG TRV
Length Width
Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
SAG TRV
AP AP Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
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Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
Don’t Mani Montazemi, RDMS Female Anatomy
Uterine Measurements
Mani Montazemi, RDMS Female Anatomy
Ovary
Mani Montazemi, RDMS Female Anatomy
Ovary
• Range in size according to the age
3Length x 2Width x 1AP cm
Mani Montazemi, RDMS Female Anatomy
Ovary
• Volume – L x W x H / 2 – Adults – 9.8cm3 (+/-5.8)
– Girls until about 5 yrs of age – < 1cm3
– Menarche – 4.2cm3 (+/-2.3)
Mani Montazemi, RDMS Female Anatomy
Ovarian Volume
3 x 2 x 2 / 2 = 6cm3
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Mani Montazemi, RDMS Female Anatomy
Follicular Cysts
Mani Montazemi, RDMS Female Anatomy
Follicular Cysts
Mani Montazemi, RDMS Female Anatomy
Follicular Cysts
• < 2.5 cm in diameter • Cysts are usually larger than a mature follicle (3-8cm) • Thin walled and unilocular • Usually unilateral • Can be multiple and bilateral
Mani Montazemi, RDMS Female Anatomy
Follicular Cysts
Mani Montazemi, RDMS Female Anatomy
Follicular Cysts
Mani Montazemi, RDMS Female Anatomy
Normal Anatomy of the
Female Pelvis
Thank You