Ultrasound of the Reproductive System Stacy Fielding

1
Ultrasound of the Reproductive System Stacy
Fielding
2
Technique

• 7.5-10mHz transducers
• 5 mHz in mid to late term pregnancy, pyometra,
  ovarian tumors
• Dorsal recumbency is routine
• Larger animals standing
• Full bladder enhances visualization of uterus
• Acoustic window

3
Ovaries

• Near caudal pole of kidney
• 1.5cm x 0.7cm x 0.5cm
• Homogenous parenchyma
• Cortex and medulla
• Hard to differentiate
• Cortex contains follicles

4
Ovaries-contd

• Anestrus/early proestrus
• Small, oval to bean shaped
• Homogenous echogenicity (like renal cortex)
• Follicles anechoic, become larger as ovulation
  approaches
• Diestrus
• CL/CH has multifocal anechoic to hyperechoic
  areas

5
Ovarian Structures
6
Ovaries

• Cystic Ovaries
• Anechoic
• Thin walls
• Acoustic enhancement
• Solitary/multiple
• Unilateral/bilateral
• May see associated pyometra or hydrometra

• Ovarian Neoplasia
• Several kinds
• Mostly unilateral
• Smooth or irregular margins
• Variable appearance
• MET CHECK!

7
Normal Uterus

• Location between urinary bladder and descending
  colon
• Various sizes
• 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

8
Normal Uterus-contd

• Uterine horns not easily identified
• Lost in mesenteric fat and small bowel echoes
• Cervix
• Hyperechoic, linear

9
Pyometra

• U/S is modality of choice for Dx
• Enlarged uterus uterine horns
• Luminal contents
• Homogenous, anechoic
• Echogenic, swirling
• May see varying wall thickness
• Endometrium may contain anechoic foci
• Ddx hydrometra, mucometra
• Monitor response to therapy

10
Uterine Neoplasia

• Adenomas
• Leiomyomas
• Leiomyosarcomas
• Isoechoic to surrounding tissue, may project into
  the lumen

11
Pregnancy Diagnosis

• 21-35 days after breeding
• Remember conception can occur several days
  afterward
• May be difficult to count fetuses
• Radiography recommended late in gestation,
  following mineralization
• Earliest change enlarging uterus
• Non-specific
• Gestational sac (blastocyst)
• First confirmatory sign
• Anechoic, several mm diameter
• Thin, hyperechoic wall
• 17-20 d

12
18 day pregnancy
13
Pregnancy-contd

• Embryo 23-25 d
• Oblong, echogenic, several mm
• Yolk sac 25-28 d
• U-shaped echogenic structure
• Extends across gestational sac
• Zonary placenta 27-30d
• Thin hyperechoic layer surrounding gestational sac

14
Fetal Viability

• Cardiac activity
• Day 23-25 post LH surge
• Fluttering echoes
• Fetal movement
• Day 35

• Fetal resorption
• before day 25
• Embryonic fluid becomes hypoechoic
• Echogenic particles
• Abortion
• After day 35
• Sonographic appearance disappears

15
Organogenesis (From Nyland Mattoon)
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
16
Prostate

• Caudal to bladder, at level of trigone
• Ventral to rectum
• Normal appearance varies
• Age
• Neuter status
• Young to middle age intact male
• homogenous, moderate echogenicity
• Smooth margins, hyperechoic rim
• Prostatic urethra
• Hypoechoic to anechoic round structure on midline

17
Prostate Diseases

• Benign Prostatic Hyperplasia
• Older intact dogs
• Symmetrical enlargement
• May be up to 4 times normal
• Variable echogenicity and texture

• Prostatitis
• Acute or chronic
• Symmetrical or asymmetrical
• Heterogenous appearance
• May see hypoechoic areas (cyst or abscess)
• Mineralization, fibrosis

18
Prostate Diseases

• Neoplasia
• Older neutered dogs
• Enlarged
• Irregular shape
• Texture varies
• Hyperechoic foci with acoustic shadowing
  mineralization
• May see cyst-like lesions
• Examine surrounding structures!

• Cysts
• Developmental or congenital
• Anechoic contents
• Thin hyperechoic wall
• Vary in size and
• Paraprostatic Cysts
• Muellerian duct remnant or extension of lobe
• Anechoic, fluid filled
• May see swirlies
• Variable wall thickness
• May see compartments

19
Prostatic Cyst
www.merckvetmanual.com
20
Testes

• Homogenous texture
• Parietal and visceral tunics
• hyperechoic
• Mediastinum testis
• Echogenic linear structure on midline
• Tail of the epididymis
• Nearly anechoic
• Coarse echotexture

21
Testicular Neoplasia

• Interstitial, Sertoli cell, seminoma
• May all appear the same
• Mixed appearance on U/S
• Hemorrhage
• Necrosis
• May obliterate mediastinum testis /- epididymis

22
Testes-contd

• Retained testes
• Small size
• Caudal to kidneys to inguinal canal
• Difficult to see on U/S

• Orchitis
• Patchy, hypoechoic parenchyma
• Hyperechoic if chronic
• Epididymal enlargement
• Abscesses
• Irregular shaped
• Hypoechoic contents
• May look like neoplasia!

23
(No Transcript)