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Body CT Modules CT of The Ovaries and Uterus
Body CT Modules CT of The Ovaries and Uterus
SeanStanley
MS3
OHSU
Fall2006
PurposeofthisPresentation
Familiarizethestudentwithlookingattheamorphous
worldofCTvisualizedpelvicanatomy.
FamiliarizethestudentwithCTvisualizedpelvic
anatomicalchangesoverthefemalelifecourse.
Exposethestudenttoafewcommonpathologiesone
mightseeonapelvicCT.
GivestudentpracticeusingCTspeakandthe
radiologyapproach.
**Caveats:itwouldprobablybebesttocometothispresentationknowingafewbasicsaboutCTandabout
generalanatomy.IfyouhaveneverseenaCTorpelvicanatomy,checkoutsomeotherbasicresourcesfirst.
Table of Contents
Normal Anatomy
Anatomic Change Over the Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
(Theyrehyperlinks,usethemtogetto
placeswithinthepresentationfast.)
AlpineMeadow,MtHood
Discerningpelvicpathologyfrompelvicanatomycanbeashard
asseparatingtheweedsfromtheflowersinthisfield.
Normal
Pelvic
Anatomy
NormalAnatomy
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Quickreviewof
normalanatomy!
Ovary
FallopianTube
Uterus
Cervix
VaginalCanal
BUTTHATSJUST
ADRAWING!!
NormalAnatomy
Herestherealthing!
Butunlessyourea
surgeon,youllnever
seethis.
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Quickreviewof
normalanatomy!
Uterus
FallopianTube
Ovary
Cervix(outof
plane)
VaginalCanal
(outofplane)
NormalAnatomy
R
Thisiswhatyoullsee:
anormalaxialpelvicCT.
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries
Fallopian
Tubes
Uterus
Cervix
VaginalCanal
Eachimageisavisualslicethroughthepelvis
NormalAnatomy
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries
Fallopian
Tubes
Uterus
Cervix
VaginalCanal
Whichbasicallyyieldsa
radiographicvisualization
ofpelvicanatomy.
NormalAnatomy
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries:
Theseovariesarerelativelyeasytosee.Manytimestheyare
notsoeasytosee,astheycanbedisplacedbythemobile
abdominalcontentsorothermasses.Lookatlateralsurfacesof
uterus,upanddownthroughplanestofindthem!
pairedorgans
ovoid/almondshaped
normallyupto4cminlength
lieoneithersideoftheuterus
variablesize/densitydependingon
whatsgoingonhormonally
a)fluiddensity(likeblood)
b)softtissuedensity(likeuterus)
c)physiologiccysts(fluidwitha
borderaroundit)
dontenhancegreatlywithcontrast
NormalAnatomy
Hmmm.Abithardertofind?
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
FallopianTubes
(oviducts):
normallydifficulttovisualizeon
CT,unlesspathology
projectfromlateralaspectof
ovariestouterinefundus
Softtissuedensity(usually
similartouterinetissue)
0.1to0.5cmindiameterat
isthmus
1cmindiameteratampulla
Dontconfusethis
withtheuterus,itsthe
bladder,notethe
density>fluid
density(urine).
NormalAnatomy
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Uterus:
pearshaped
aboutthesizeofhumanfist
(8x5x2.5cm)
softtissuedensity(itsmostlya
bigmusclecompareto
pelvicmuscle.)
triangularendometrialcavity
within(fluidfilled/density),
viewedinonlycertain
planes
variesinsize/densitydepending
onage/parityofwoman
FlowersatMt.Hood
Areyoustartingtodiscernthings?
Youmustlearnhowtolookbeforeyoucansee.
The Approach
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Slide a: Describe what you see (using CT terminology density, mass, heterogeneous, and other words that lead
to understanding without jumping to a diagnosis - CT is an aid
to diagnosis, to be weighed alongside clinical and other lab
data, not necessarily a diagnosis clincher.)
Slide b: Read an example description, and brainstorm possible
diagnoses that could present radiographically like that given
description.
Slide c: Find out the answer and read a bit about it!
The Approach
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
(CT is all about description - you cant really tell what something is
by one glance at a CT, but you can tell how it looks!)
Attenuation (density)
NormalAnatomicChangeOverthe
FemaleLifecourse
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Becausetheovariesanduterusarepartof
thereproductivesystem,theirfunction
changesastheindividualmaturesandages.
Functionalchangesarereflectedinthe
anatomyasvisualizedbyCT.
NormalAnatomicChange
OvertheFemaleLifecourse
4yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase1a
Describewhatyousee
insidetheoutline.
Thisiswhereyoushouldsay,Iseeasmall
softtissuedensityuterinetissueinthemid
pelvis,betweenabladderfilledwith
homogeneousfluiddensityblahblah
blah
NormalAnatomicChange
OvertheFemaleLifecourse
4yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase1b
SampleDescription:
b
r
Narrowstripofsofttissueattenuation
uterinetissue,nestledbetweena
normalfluidattenuatedbladder(b),
andanormalstoolfilledrectum(r).
OviductsandOvariesare
indistinguishablefromsofttissue
densityuterus.
Whymighttheuteruslook
thatway?
NormalAnatomicChange
OvertheFemaleLifecourse
4yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase1c
PremenarchalStage
uterus
OVARIES:
::are1/3ofadultsize(thereforedifficult
tovisualize)
::havelessmaturefollicles,thereforeare
moredenseclosertosofttissuethanfluid
::ifvisualized,ovariescanhavenormal
microcystsupto0.9cm
UTERUS:
::small
::nonengorged,thereforeenhancesless
withcontrast
NormalAnatomicChange
OvertheFemaleLifecourse
33yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase2a
Describewhatyousee.
Again,hereiswhereyoushouldsay,Isee
alargersofttissuedensityuterinetissuein
themidpelviswithsomeregionsof
hyperdensityetcandsoforth
NormalAnatomicChange
OvertheFemaleLifecourse
33yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase2b
SampleDescription:
Engorged,greaterthansofttissue
attenuation,contrastenhancing
uterinetissue,flankedbynormal
sizedovarieshavingsome
heterogeneitiesoffluidorsofttissue
attenuation.
Whymighttheuterusand
ovarieslookthatway?
NormalAnatomicChange
OvertheFemaleLifecourse
33yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase2c
Premenstrual/Menstrual
Stage
UTERUS:
::enlargestomoreglobularshape,dueto
endometrialproliferation
::becomesmorevascular(notehigher
attenuationthanpelvicmuscle)
OVARIES:
::enlargetoalengthofupto7cm.
::stillconsistofnormalovariantissue(just
possiblymoreofit!)
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase3a
Describewhatyou
see.
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase3b
SampleDescription:
-
highlydilateduterinetissueof
mildlycontrastenhancingsofttissue
density,containingatitscentera
cavitymainlyoffluiddensity
attenuation,butcontainingsome
peripheralregionsof
heterogeneouslyenhancingsoft
tissueattenuationandamorphous
centralfociofboneattenuation.
Whymighttheuteruslook
thatway?
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase3c
Parous/PregnantStage:
(itsababy!)
UTERUS:
::theuterinecavityenlargesandisfilled
withfetalmaterialandamnioticfluid.
::placentaisvisibleattherimofuterine
endometrium,andhastheattenuation
somewhereinbetweensofttissueand
fluid/blood(thinkaboutthepurposeof
theplacenta!)
NormalAnatomicChange
OvertheFemaleLifecourse
27yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase4a
Describewhatyou
see.
NormalAnatomicChange
OvertheFemaleLifecourse
27yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase4b
SampleDescription:
-
enlarged,heterogeneousuterine
tissueofsofttissueattenuation
withoutgeneralcontrast
enhancement,butwithperipheral
scatteredregionsofenhancement
Whymighttheuteruslook
thatway?
NormalAnatomicChange
OvertheFemaleLifecourse
27yearold
Heresanotherpostpartumuterus,
notethesmallamountoffreeair
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase4c
Postpartumstage
(Shejusthadababy!)
UTERUS:
::enlarged,avgsizeof9x12x14cm.
::maystillhaveengorgedvessels.
::smallamountsofintrauterinefluidor
bloodarenormalinthefirst24hrspost
delivery
::smallamountsofintrauterineairoccurs
in~25%ofpostpartumwomen
::Uterinesizereturnstonormalin68
weeksafterdelivery
NormalAnatomicChange
OvertheFemaleLifecourse
66yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase5a
Describewhatyou
see.
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase5b
66yearold
SampleDescription:
-
normalsizeduterinetissueofsoft
tissueattenuationwithsomesmall
fociofcontrastenhancement,
flankedbysmall,denseovariesof
softtissueattenuation,without
significantfluidenhancement.
Whymighttheuterusand
ovarieslookthatway?
NormalAnatomicChange
OvertheFemaleLifecourse
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Lifecoursecase5c
66yearold
Postmenopausalstage
UTERUS:
::sizedecreases(duetouterine
endometriumatrophy)
::losesitscyclicengorgement
OVARIES:
::small
::featureless(thefolliclesarenolonger
underhormonestimulation)
::uniformlysofttissuedensity
Mt.JeffersonfromhikeupMt.Hood
Youregettingthere
Pathologies
ExamplePathologies
Nonneoplasm
Ovarian/tubal
- Uterine
- Pregnancyassociated
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Neoplasm
Ovarian
Uterine
Cervical
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovarian/Tubal
Note:Thisisinnoway
OvarianCysts(+/rupture)
meanttobea
PelvicInflammatoryDisease
comprehensivelistof
TuboOvarianAbscess
pathologies.Theseare
OvarianTorsion(adnexaltorsion)
justafewcommonones
Uterine
togiveyoupractice
Fibroids(myoma)
lookingatthepelvicCT.
PregnancyRelated
Ectopicpregnancy
Traumaduringpregnancy/FetalDemise
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase1a:
Describewhatyousee.
(Ignorethearrows,
theyreshowingbowel
inflammationofCrohns
Disease.)
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase1b:
ExampleDescription:
Normalsofttissue
attenuationuterusflankedby
ovarieseachofwhichexhibit
markeddilationandhaving
wellcircumscribedwalled
cysticcavitiesfilledwith
materialoffluidattenuation.
Thereisasmallregionof
unboundfluidattenuation
posteriortotheuterus.
Whatarepossiblepathologies?
PathologyNonneoplasm
CorpusLuteal
cyst
uterusFunctional
cyst
NotethedifferencesCysticovary
influiddensity
Freefluid=rupture!
Anotherpatient
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase1c:
Ovariancysts
::wellcircumscribed
::usually<5cm
::homogeneous,lowattenuation
contents
::absenceofinternalarchitecture
::varioustypes:
a)functional(physiologic)
b)corpusluteal
thickened,crenulatedwall
oncontrastenhancedCT
higherdensityfluid
mostlikelytoruptureor
hemorrhagecausingacuteabd
c)follicular
higherdensityfluid
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase2a:
Describewhatyou
see.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase2b:
SampleDescription:
enlargeduterusofsofttissue
attenuation,flankedatthe
posterioraspectsbytortuous,
thickwalledoviductsfilledwith
materialoffluidattenuation.
Whatarepossible
pathologies?
PathologyNonneoplasm
Dilatedoviducts
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase2c
PelvicInflammatory
Disease
EarlyPID
::dilatedandenhancingfallopian
tubes(inflamed)
::periovarianstranding
ProgressingPID
::loculatedorcomplexfluid
collections
::abnormalendometrialfluidand
enhancement
LatePID
::possibletuboovarianorpelvic
abscess,
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase3a:
Describewhatyou
see.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase3b:
SampleDescription:
-
softtissueattenuationuterinetissue,
pressedtotheanteriorpelvicwallby
amassatitsrightposterioraspect.
Thismassislarge,heterogeneous,
havingareasofsofttissueattenuation
andareasoffluidattenuation.Theleft
ovaryisnormalandisvisualizedat
theleftposterioraspectoftheuterus.
Therightovaryisnotdisctinctly
visualized.
Whatarepossiblepathologies?
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase3c:
TuboovarianAbscess
Tuboovarianabscess
Lovary
::sequelaeofPID
::inadnexalregion
::thickwalledfrom
inflammation
::fluiddensityregions
::internalseptation
PathologyNonneoplasm
Thisisahardone!!!
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase4a:
Describewhatyou
see.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase4b:
SampleDescription:
-
Amorphousanteriorabdominal
regionofgreaterthansofttissue
attenuation,mildlyenhancingin
aconcentricorswirlingmanner.
Theborderswithsurrounding
tissuesareindistinct.Uterusand
ovariesareindistinctinthis
plane.
Whatarepossiblepathologies?
PathologyNonneoplasm
Swirlofthetorsingovarianpedicle
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Ovaries/Tubescase4c:
OvarianTorsion
::partialorcompleterotationofthe
ovarianpedicleincludingtheovarian
vasculature
::usuallyappearsasanadnexalmass
hyperdensecomparedtocontralateral
ovary
::thetorsedovarymaybecystic,
containingsmallareasofhypodense
fluid
::occursinnormalorpathologically
enlargedovaries.
::cancauseacuteabdomenin
adolescentsandelderly
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Uteruscase1a:
Describewhatyou
see.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Uteruscase1b:
SampleDescription:
-
Mildlyenhancing,softtissue
densityuterinetissueinmidpelvis,
flankedbilaterallybytwolarge,
relativelywellcircumscribed,soft
tissuedensitynodularmasses.
Posteriortotheflankingmasses,lie
twocysticcollectionsoffluid
attenuation.
Whatarepossiblepathologies?
PathologyNonneoplasm
Subserosalfibroids
Inthiscase,thefibroidsblockedtheoviducts
entryintotheuterus,thereforeoviductal(ft)swelling!
Butfibroidsmaybelessdramatic,suchasinthis
patient:notethelowattenuationintramuralfibroids
inthemyometrium(muscularuterus).
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Uteruscase1c:
Fibroids
(myoma/leiomyoma)
::canbeindistinguishable,inattenuation,
frommyometriumonnoncontrastCT
::canbeheterogeneous,thereforehypo,
iso,orhyperdensetonormalmyometrium
oncontrastCT
::commonlycauseenlargementofthe
uteruswithlobulation
::threetypes(basedonlocationrelativeto
themyometrium)
submucosal
intramural
subserosal
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase1a:
Description.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase1b:
SampleDescription:
-
Softtissuedensityuterinetissueinmid
pelviswithindistinctborders.Totheright
of,slightlyposteriorto,andpossibly
contiguouswiththeuterinetissue,isa
heterogeneouscollectionoftissue.This
collectionoftissuehassomeregionsof
enhancingsofttissuedensityandothersof
fluiddensity.Posteriortothis
heterogeneouscollectionisathinwalled
cysticstructurecontainingacentralfluid
densitycavity.Generallyinthepelvisand
surroundingmanyorgans,thereisalarge
amountoffreeflowingfluidattenuation
material.
Whatarepossiblepathologies?
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase1c:
Ectopic/TubalPregnancy
::heterogeneoustissuemostcommonlyin
thefallopiantube,butalsolesscommonly
intheperitoneum.
::cancontainregionsofvarious
attenuation,fromlowdensitywater
attenuationtohighdensitycalcium
deposits(rememberthisisapregnancy!).
::canbeaccompaniedbycysticdilationin
thefallopiantubeorovary
::mayrupture,spillingfluid/bloodintothe
peritonealcavityoruterus.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase2a:
Describewhatyou
see.
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase2b:
SampleDescription:
Uterusisgreatlydilatedandthick
walledwithoutgreatenhancement.
Withintheuterusandcontinuouswith
itsrightaspectisathickeningofnon
enhancing,softtissuedensitytissue.
Alsowithinthedilateduterusarea
numberofheterogeneousfoci
containingtissueofvarious
attenuations,fromfluidtobone
density.
Whatarepossiblepathologies?
PathologyNonneoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Pregnancyrelatedcase2c:
FetalDemise(dueto
maternaltrauma)
::uterinesizemayremainunchanged
frompriortotrauma
::lowattenuation,nonenhancing
fetaltissuesdenotesbloodsupplyto
fetushasbeendisrupted
::lowattenuation,nonenhancing
placentaindicatesadisruptionin
bloodflowtotheplacenta(trauma
cancauseprematureseparationofthe
placentafromtheuterinewall,
therebycuttingoffbloodsupplyfrom
maternalcirculationleadingto
spontaneousabortion.)
PathologyNeoplasm
Ovarian
Teratoma(MatureDermoidCyst)
SerousCystadenoma
MucinousCystadenoma
Cystadenocarcinoma
Uterine
EndometrialAdenocarcinoma
Cervical
CervicalCarcinoma
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
Again,thisisinnoway
meanttobea
comprehensivelistof
neoplasms.Remember,
thisisforthepracticeof
looking!
PathologyNeoplasm
Clue:thisarisesfromleftovaryina13yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase1a:
Describewhatyou
see.
PathologyNeoplasm
Clue:thisarisesfromleftovaryina13yearold
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase1b:
SampleDescription:
Withinthemidpelvisthereisa
large,thinwalled,cysticstructureof
predominantlyfluidattenuation
material.Attheperipheryofthis
structureareafewdistinctregionsof
heterogeneoustissue.Withinthethe
rightlateralaspectliesafociofbone
densitymaterial.Withintheleft
lateralaspectliesaheterogeneousfoci
offatandsofttissuedensities.
Whatarepossiblepathologies?
PathologyNeoplasm
Heresanotherpatient:
Clue:thisarisesfromleftovaryina13yearold
Notethevarioustissuetypeswithintheteratoma.
Toothcalcifications
Rokitanskynodule:
Histologicallydiversetissue fat,muscle,skin,hair?
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase1c:
Teratoma
(MatureDermoidCyst)
::asquamouscelllinedcystic
lesionarisingfromtheovary
::cancontaintissuesofvariouscell
lineages,allarisingfromthegerm
celllayershair,skin,teeth,fat,etc.
::cancontainRokitanskynodules
(denseclustersofmultipletissue
types)attheperiphery.
::UsuallyBENIGN(98%),despite
thescariness!
PathologyNeoplasm
Clue:thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase2a:
Describewhatyou
see.
PathologyNeoplasm
Clue:thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase2b:
SampleDescription:
Attheposterioraspectofthe
pelvisliesawellcircumscribed,
thinwalled,nonseptatedcystic
structurecontainingfluiddensity
material.Surroundingtissue
stoolfilledrectum,colon,and
smallbowelarenotaffected.
Whatarepossiblepathologies?
PathologyNeoplasm
Clue:thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase2c:
SerousCystadenoma
Hereitisfroma
frontalperspective
::BENIGN!
::arisesfromovary
::wellcircumscribed(no
invasionofothertissues)
::thinwalled
::homogeneouscentralfluid
attenuation
::noseptations(incontrastto
mucinouscystadenoma,another
benigntumor)
::canbebilteral(~25%)
PathologyNeoplasm
Clue:Thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase3a:
Describewhatyou
see.
PathologyNeoplasm
Clue:Thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase3b:
SampleDescription:
Theabdominalcavityisnearly
completelyfilledbyalarge,well
circumscribed,thinwalled,
septatedcysticstructure.The
cavitiesofthisstructurearefilled
withahomogeneousmaterialof
fluiddensity.Otherabdominal
contentscontrastfilledsmall
bowelarecompressedlaterally
butareotherwisenormal.
Whatarepossiblepathologies?
PathologyNeoplasm
Clue:Thisarisesfromtheovary
Yes,thishugethingis
comingfromtheovary.
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase3c:
MucinousCystadenoma
::BENIGN!
::arisesfromovary
::wellcircumscribed(no
invasionofothertissues)
::thinwalled,butthickerthan
serouscystadenoma
::homogeneouscentralfluidof
higherthanwaterattenuation
::SEPTATIONSpresent(in
contrasttoserouscystadenoma)
::muchrarerthanserous
cystadenoma
PathologyNeoplasm
Clue:Thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase4a:
Describewhatyou
see.
PathologyNeoplasm
Clue:Thisarisesfromtheovary
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase4b:
SampleDescription:
Thepelviccavityisgrossly
distendedbymultiplewell
circumscribed,thinwalled,
septated,lobularstructuresof
fluiddensity.Thesestructuresare
compressingbutdontseemto
invadingsurroundingpelvic
tissues.
Whatarepossiblepathologies?
PathologyNeoplasm
Clue:Thisarisesfromtheovary
(noticetheseptationsand
thelobulatedsurface,as
comparedtothesmooth
benigntumors)
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
OvarianNeoplasmcase4c:
Cystadenocarcinoma
::MALIGNANT!
::arisesfromovary/ovaries
::partiallysoldorlobulated
::papillaryprojections,
septations,andprominent
vasculaturemaybepresent
::mayhavemalignantextensions
intosurroundingtissueuterine,
colonic,bladderlookfor
blurringofdistincttissueborders
withsomeinflammatorychange
(note:thereisnoinvasioninthis
exampleCTsection).
PathologyNeoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
UterineNeoplasmcase1a:
Describewhatyou
see
PathologyNeoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
UterineNeoplasmcase1b:
SampleDescription:
Theuterusisinmidpelvisand
hasnormalsofttissuedensity
aroundahomogeneousfluid
densitycentralcavity.Thereisa
small,focalregionoflower
densityendometrialtissueonthe
anterioraspectoftheuterine
wall.Thereisalsosomeblurring
oftheanteriorborderofthe
uteruswithsurroundingpelvic
tissue.
Whatarepossiblepathologies?
PathologyNeoplasm
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
UterineNeoplasmcase1c:
Checkoutthe
Notetheextensionfromtheanterioruterinewall
adenocarcinomagrowth Endometrial
theendometrialwall!
Adenocarcinoma
Andpossiblysome
extensioninto
surroundingtissues
::MALIGNANT!
::arisesfromuterinewall
::onnoncontrastCT,istypically
isodensetouterinewallanddifficult
tovisualize
::oncontrastCT,typically
enhancesmorethansurrounding
uterinetissue
::mayhavemalignantextensions
intosurroundingtissueuterine,
colonic,bladderlookforblurring
ofdistincttissueborderswithsome
inflammatorychange
PathologyNeoplasm
Clue:Thisarisescaudaltotheuterus
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
CervicalNeoplasmcase1a:
Describewhatyou
see.
PathologyNeoplasm
Clue:Thisarisescaudaltotheuterus
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
CervicalNeoplasmcase1b:
SampleDescription:
Thecervixismidpelvis,between
thebladderandtherectum.It
showsmildlyenhancingsofttissue
densitywithsmallfocalregionsof
highdensity.Itscentralcavityis
heterogeneouslyfilledwith
materialsoffluiddensityandsoft
tissuedensity.Theexternalborders
oftheuterinecervixareindistinct
circumferentially,blurringwiththe
uterusanteriorlyandtherectum
posteriorly,aswellassurrounding
theuretersbilaterally.
Whatarepossiblepathologies?
PathologyNeoplasm
Clue:Thisarisescaudaltotheuterus
Normal Anatomy
Anatomic Change Over the
Lifecourse
Example Pathologies
Non-neoplasm
Neoplasms
CervicalNeoplasmcase1c:
CervicalCarcinoma
::MALIGNANT!
::arisesfromcervicaltissue
::cervicalmassorenlargement
::potentialareasoflowattenuation
secondarytonecrosis,ulceration,or
reducedvascularity
::mayhaveirregular,malignant
extensionsintosurroundingtissue
uterine,colonic,bladderlookfor
blurringofdistincttissueborderswith
someinflammatorychange
::onlycontrastCTcandistinguish
irregularhypodensebordersoftumor
thenormalcervicaltissue
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Mt.Hood
Thatsit.Thatisasfarasweregoingthistime.
Theresmoreclimbahead,butyoucanblazeyourown
path.