Topic: Vascular Structure of

Uterus
Syeda Khadija
PhD*, MSDU(Ultrasound)
Assistant Professor Department (UIRSMIT) FAHS
University of Lahore www.uol.edu.pk
E-mail:syyedakhadija55@gmail.com
Courtesy by Prof. Dr. Amir Gilani

Uterine Vessels
• Uterine arteries, from the internal iliac
• Run along the sides of the uterus, joins
branches from the ovarian artery
• Branches dip into the uterine substance and
form the “arcuate” arcade
• These give off radial and spiral arteries that
move inwards to the endometrium
• The arcuate arteries lie between the outer and
intermediate layers of the myometrium and branch
into the radial arteries, which run in the intermediate
layer to the level of the inner layer. The radial
arteries then branch into the spiral arteries, which
enter the endometrium and supply the functional
layer.
• The uterine veins are larger than the accompanying
arcuate arteries and are frequently identified as
small, focal anechoic areas by both trans abdominal
and transvaginal sonography. This vascular pattern
can be confirmed by Doppler ultrasound.
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Uterine Arteries

Uterine

Arcuate

Radial
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Uterine Arteries
• Possible to see with Doppler
• In the non gravid pelvis, probably not very
important
• But should know of normal spectrum
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Uterine Arteries
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Arcuate Vessels
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Arcuate Arteries
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Radial and Spiral Arteries

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Calcification may be seen in the arcuate arteries in

postmenopausal women because of Mönckeberg’s
sclerosis. On sonography, such calcification appears
as peripheral linear echogenic areas with shadowing;
they should be distinguished from calcified
leiomyomas This is a normal aging process that may
be accelerated in diabetic patients.
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Calcified Arcuate Vessels

(Monkebergs Sclerosis)
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Calcified Arcuate Vessels

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Cervix
• Difficult to differentiate cervix from lower
part of the body in non-gravid state
• Has thin endometrial line
• Nabothian cysts are very common
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Cervix
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Definition of cervix
• The cervix of the uterus, also known as the
the narrow neck-like passage forming the
lower end of the womb, attaches the vagina
to the uterus.
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Cervix ,vagina
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Size of the cervix

• It is approximately four to five centimeters
long, however, the length of the cervix can
be affected by age and childbirth.
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• During childbirth, the cervix thins out and

eventually dilates (expands) to 10
centimeters to allow the baby to pass
through the birth canal. Once the baby is
born and the placenta is expelled, the cervix
begins to thicken and close.
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• Cervical polyps are a frequent cause of vaginal

bleeding and may be seen on sonography, although
the diagnosis is usually made clinically.
Approximately 8% of leiomyomas arise in the
cervix. They may be pedunculated and may prolapse
into the vagina. In patients who underwent
supracervical hysterectomy, the cervical remnant
occasionally simulates a mass. Transvaginal
sonography is usually diagnostic; it can demonstrate
a normal cervix. The cervical remnant may measure
up to 4.4 cm in AP diameter and 4.3 cm in length.
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• Cervical stenosis may be secondary to previous

radiation therapy, previous cone biopsy,
postmenopausal cervical atrophy, or cervical
carcinoma.
• Cervical carcinoma is usually diagnosed clinically,
and patients are rarely referred for sonographic
evaluation.
• Sonography may demonstrate a solid retrovesical
mass, which may be indistinguishable from a
cervical fibroids.
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Cervical length measuring
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Transvaginal ultrasound of the

Cervix
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Cervical length in pregnancy

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IUCD in cervix
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Cervical incompetence
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Multiple nabothian cysts in cervix

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Nabothian Cysts
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VAGINA

• The vagina runs anteriorly and caudally

from the cervix between the bladder and
rectum. It is best seen on midline sagittal
sonograms with a slight caudal angula
Fretion of the transducer.
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It appears as a collapsed hypoechoic tubular structure
with a central, high-amplitude, linear echo
representing the apposed surfaces of the vaginal
mucosa. The most common congenital abnormality of
the female genital tract is an imperforate hymen
resulting in hematocolpos. Occasionally, sonography
is used to characterize a vaginal mass. Gartner’s duct
cysts are remnants of the caudal end of the
mesonephric duct that form single or multiple masses
along the lateral or anterolateral wall of the vagina.
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• These are the most common cystic lesions

of the vagina and are usually found
incidentally during sonographic
examination.
• In patients with hysterectomy, a vaginal cuff
should not be mistaken for a mass.
upper limit of normal for the vaginal cuff to be 2.2
cm in women who had a transvaginal hysterectomy
and 2.4 cm in those that had a transabdominal
hysterectomy.
• Also, the AP diameter decreased significantly with
advancing age, and color Doppler ultrasound
typically showed flow within the cuff. A cuff larger
than 2.2 cm or containing a definite mass suggests
malignancy.

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