Inflammatory & Infectious Uterine Disorders
This uterine condition often occurs in the postpartum period and presents with a thickened endometrium, fever, and foul discharge; ultrasound may show echogenic material in the cavity.
What is retained products of conception (RPOC)?
This benign proliferation of endometrial glands is often caused by unopposed estrogen and can be classified as simple or complex, with or without atypia.
What is endometrial hyperplasia?
What is the most common type of endometrial carcinoma?
A. Clear cell
B. Squamous cell
C. Adenocarcinoma
D. Sarcoma
Answer: C. Adenocarcinoma
A submucosal fibroid would most likely appear as:
A. A hypoechoic mass distorting the endometrial cavity
B. A well-circumscribed lesion in the serosal layer
C. A hyperechoic lesion within the cervical canal
D. An anechoic cyst within the posterior cul-de-sac
Answer: A – Submucosal fibroids distort or compress the endometrial cavity and appear hypoechoic
22-year-old presents with lower abdominal pain and fever. Transvaginal ultrasound shows thick endometrium with fluid and gas. Diagnosis?
A. Endometritis
B. Endometriosis
C. Cancer
D. Myoma
Answer: A. Endometritis
This rare condition refers to bacterial invasion of the myometrium and often coexists with endometritis; ultrasound may show an enlarged, ill-defined uterus.
What is myometritis?
This benign lesion, which arises from the cervix, may appear as a hypoechoic mass with a feeding vessel and can cause postcoital or intermenstrual bleeding.
What is a cervical polyp?
Endometrial thickness greater than ___ mm in a postmenopausal woman warrants further evaluation.
A. 2
B. 4
C. 6
D. 8
Answer: B. 4
Which of the following sonographic findings is most characteristic of adenomyosis?
A. Well-defined hyperechoic mass with calcifications
B. Thin endometrial stripe with posterior shadowing
C. Heterogeneous myometrium with small cystic spaces
D. Anechoic tubular structure adjacent to the uterus
Answer: C – Adenomyosis often presents with diffuse myometrial heterogeneity and myometrial cysts.
35-year-old woman has heavy menses and bulky uterus with heterogenous myometrium and tiny cysts. Most likely diagnosis?
A. Leiomyoma
B. Endometritis
C. Adenomyosis
D. Cancer
Answer: C. Adenomyosis
This serious infection spreads beyond the uterus to involve the broad ligaments and pelvic connective tissues, often following childbirth or pelvic surgery.
What is parametritis?
The ectopic occurrence of endometrial tissue within the myometrium and is more common in the posterior aspect.
What is Adenomyosis?
What is the hallmark symptom of endometrial carcinoma?
A. Pelvic pain
B. Postmenopausal bleeding
C. Dyspareunia
D. Vaginal discharge
Answer: B. Postmenopausal bleeding
What is the most typical sonographic feature of a uterine leiomyoma (fibroid)?
A. Isoechoic solid mass with posterior enhancement
B. Hypoechoic mass with peripheral flow and shadowing
C. Anechoic tubular lesion with fluid-fluid levels
D. Irregular echogenic endometrium with ascites
Answer: B – Fibroids are hypoechoic, shadowing, and often show circumferential vascular flow.
Postmenopausal woman with incidental finding of arcuate artery calcifications. Diagnosis?
A. Myoma
B. Atherosclerosis-related calcification
C. Hyperplasia
D. Cancer
Answer: B. Atherosclerosis-related calcification
This accumulation of purulent fluid in the uterine cavity may result from cervical stenosis, cancer, or infection and appears as echogenic or complex intrauterine contents.
What is pyometra?
This benign vascular anomaly presents with profuse bleeding and on Doppler shows a "mosaic" pattern of high-velocity, low-resistance flow.
What is a uterine arteriovenous malformation (AVM)?
Which ultrasound feature suggests malignancy?
A. Thin endometrium
B. Anechoic mass
C. Irregular endometrial borders and heterogeneity
D. Small hyperechoic foci
Answer: C. Irregular endometrial borders and heterogeneity
Which of the following is least likely to appear as a mass in the uterus on ultrasound?
A. Polyp
B. Nabothian cyst
C. Subserosal fibroid
D. Endometrial carcinoma
Answer: B – Nabothian cysts are cervical, not uterine, and typically appear in the cervix as anechoic cysts
40-year-old with irregular bleeding and focal mass in endometrium on US. First-line diagnosis?
A. Endometrial carcinoma
B. Fibroid
C. Polyp
D. Hyperplasia
Answer: C. Polyp
On ultrasound, this postpartum complication may appear as echogenic foci with posterior dirty shadowing or reverberation artifacts within the endometrium.
What is postpartum endometrial gas infection?
These benign, echogenic foci in the uterine wall are most often seen in postmenopausal women and typically result from degenerative changes in small arteries.
What are uterine arcuate artery calcifications?
Uterine sarcomas typically arise from the:
A. Cervical epithelium
B. Endometrial glands
C. Myometrium
D. Peritoneum
Answer: C. Myometrium
A fibroid undergoing degeneration may appear:
A. Completely anechoic with internal septations
B. Uniformly hyperechoic with smooth margins
C. Complex with cystic degeneration and calcification
D. Asymmetric and irregular with no Doppler flow
Answer: C – Degenerating fibroids may appear complex with areas of cystic change and/or calcifications.
Patient with history of PID and gas within the endometrium on ultrasound. Most likely diagnosis?
A. AVM
B. Endometrial carcinoma
C. Pyometra
D. Tubo-ovarian abscess
Answer: C. Pyometra