(A) A normal intrauterine pregnancy: longitudinal image.

Showing
double decidual sac sign (arrows). YS = yolk sac; BL = bladder.
(B) First trimester gestational sac
Pseudogestational sac. Patient with an ectopic gestation. M =
myometrium. (B) Pseudogestational sac
 (A) A missed abortion. The rather amorphous embryo is marked
by cursors. No fetal heart identified. Sonographic age 7 weeks,
compared with a menstrual age of 10 weeks
(B) Blighted ovum: transvaginal image showing empty gestational
sac (+) measuring 2.6 cm in length. No fetal pole or yolk sac identified.
 (A) An irregular gestational sac (S) with weak decidual reaction and embryonic
remnants (cursors). No fetal heart identified. The menstrual age was 12 weeks
(B) Thickened amniotic membrane. A 2 mm fetal pole (F) was
identified in this pregnancy with a menstrual age of 12 weeks. No fetal heart identified
 Ectopic pregnancy noted in the right adnexa at a menstrual
age of 7 weeks 3 days. A beating heart was noted in the embryo (E)
and a yolk sac (Y)
 Ectopic pregnancy. A complex adnexal mass (M) in a patient
found at surgery to have a ruptured fallopian tube. The ovary (0)
containing follicles (F) is seen adjacent to the mass.
(A,B) Anencephaly in two fetuses showing prominent orbits
(arrows) and an absence of cerebral tissue more cranially
Encephalocele (small arrows) with visible sulci.
D = calvarial defect.
 Cervicothoracic meningioencephalocele. Longitudinal (A) and
transverse (B) images with grossly abnormal distal spine (C, arrows).
 (A) defek berupa putusnya garis echo dari tulang belakang dan
meningiocele. (B) Potongan sagital tulang belakang menunjukkan
adanya meningocele pada lumbal. Tampak defek spinal yang luas dari
L2 sampai S3.
Meningocele: transverse image. S = sac containing only fluid;
poc = splaying of the posterior ossification centres
Meningomyelocele: transverse image. Short arrows = sac containing
neural elements; poc = splaying of the posterior ossification
 Cervical spina bifida: longitudinal (A) and transverse (B) images.
Note the 'V' shape rather than the normal 'ring' of ossification centres
on the transverse image
 Abnormalitas fetal cranial contour (the 'lemon sign) and of the
cerebellum (the 'Banana sign' ). These signs have been shown to Be
useful predictors of spina bifida
 Dandy walker syndrome. The posterior fossa cyst measures
12 x 9 mm in this fetus with a gestational age of 19 weeks. A
hypoplastic cerebellum was identified and there was also
ventriculomegaly with a ventricular atrium measuring 14 mm across.
 Alobar holoprosencephaly:
T = fused thalami; MV = monoventricle; arrows = cortical mantle
 Semilobar holoprosencephaly: transverse image. MV=
monoventricle; small arrows = anterior cortex with no
interhemispheric fissure; large arrow = posterior falx. On this image
there is no distinction from the alobar form.
• Dandy-Walker syndrome (DWS) This results from abnormal
development of the cerebellum and fourth ventricle. Atresia
of the foramina of Luschka and Magendie, with hypoplasia or
aplasia of the cerebellar vermis, leads to dilatation of the
fourth ventricle and expansion of the posterior cranial fossa.
 Hydranencephaly: sagittal (A), anterior coronal (B), transverse
(C) and posterior coronal (D) images. Note the brainstem surrounded
by fluid (arrows, A,B) and an absence of cerebral cortex (diganti fluid).
fn (D) the tentorium (small arrows) can be seen above a normal
posterior fossa. c = cervical spine
Hydrops fetalis (A) transverse image. P = pleural effusions; H = heart;
SP = spine (B,C) Gross ascites, outline hepar janin, dan edema kulit
minimal.
Diaphragmatic hernia: S = stomach, herniated into chest; H = heart;
arrows – hypoechoic diaphragm. Note the polyhydramnios
Hernia diafragmatika sisi kiri. Tampak ‘cystic mass’ dari gaster pada hemithoraks
kiri dan bergesernya jantung dari posisi normal
 (A) Cystic hygroma: longitudinal image. H - head; C - small
cystic lesion in occipitocervical region. Despite the relatively small size
of this hygroma it was associated with extensive lymphoedema.
(B) C= large ocipitocervical cysts with a prominent midline septation
(arrows)
 Omphalocele: Defect ventral abdomen with herniation of the
intraabdominal contents (Bowel loops, stomach and liver) into the
base of the umbilical cord
Prune-belly syndrome: The combination of a hypotonic abdominal
wall, large hypotonic bladder with dilated ureters, and cryptorchidism
 Sacrococcygeal teratoma: longitudinal (A) and transverse (B)
images. CT = cystic teratoma at lower end of spine; I and E = intra- and
extrapelvic components respectively; arrows = pelvic bones
F = fetus; A = amniotic fluid. (A) Subchorionic haemorrhage
(arrows). (B) Amnion-chorion separation (arrows).
A. Haemorraghe retroplacenta
B. Placental abruption
Multiple hypoechoic placental infarcts (arrows) in a
patient with a systemic vasculitis. F = fetus
 Agenesis of the corpus callosum : The absent corpus callosum
is arrowed in A. In B there is a high-riding third ventricle and crescentic
lateral ventricles (arrowed) compressed by Probst bundles.
Clot dari solid nodule within a normal corpus luteum (arrows).
Collapsing corpus luteum. Irregularly shaped echogenic cyst
(arrowheads)
Polycystic ovary. (A) Central and peripheral cysts.
(B) Peripheral cysts
Multifollicular ovary (arrows) in a patient with amenorrhoea
due to anorexia nervosa
 Thickened irregular endometrium (arrows) due to
tamoxifen. Note the small cysts (arrowheads) at the myometrial
endometrial interface
 (A) Imperforate hymen: Longitudinal scan demonstrates a large
heterogeneous mass due to blood-filled distended vagina (arrows) . A
small uterus and cervix (arrowheads) (B) two uterine bodies
 (A) Two separate uterine horns indicative of bicornuate
uterus. Arrowheads indicate position of endometrium
(B) Two endometrial echoes (arrows) within the uterus, suggestive
of a uterine septum.
 Fibroid polyp. (A) within the cervical canal. The stalk of the polyp
(arrowheads) can be seen in the uterine cavity. (B) Same patient 6 months
earlier. The fibroid polyp (arrows) is now seen within the uterine cavity.
(A) Typical mural fibroids (arrows) abutting (berbtsan) the cavity
(arrowheads). Recurrent shadowing (+)
(B) Typical recurrent shadowing (arrowheads)
Two subserosal fibroids (arrows). Arrowheads indicate
position of uterine cavity.
Differential diagnosis of fibroids
Location Differential diagnosis
Submucosal Endometrial polyps
Retained products of conception (RPC)
Endometrial Ca
Retained products of conception (RPC)
Mural/subserosal Adenomyoma /adenomyosis=internal
endometriosis
Leiomyosarcoma
Myometrial contraction
Metastatic deposits
Pedunculated Any cause of solid adnexal mass
Multiple endometrial polyps. Endometrial line (arrows) are
displaced by the polyps
Endometrial thickening. DD: hyperplasia , polyp
Saline hysterography. Endometrial polyp outlined by saline
Poorly defined intrauterine mass due to endometrial
carcinoma.
Obstructed uterus. The cavity (arrows) is distended by
blood with a polypoid mass due to endometrial Ca
 Ca cervix. Large irreguler cervix (arrowheads)
with a small tongue of tumour (arrow) extending towards the bladder.
Cervical carcinoma invading bladder base (arrows) and
causing an obstructed uterus (arrowheads)
Paraovarian cysts may reach up to 10 cm
Hydrosalpinx (arrows) adjacent to the ovary (arrowheads)
Endometrioma (chocolate cysts)-Cystic mass product endometriosis,
thick wall, internal echoes due to old blood
Typical endometrioma with diffuse moderately high-level
echoes (arrows).
 (A) Bilateral endometrioma. Note the fluid level on the left
and the irregularly thickened wall
(B) Endometriosis. Complex ovarian mass with internal septations
and echoes of varying density. Differential diagnosis must include a
malignant tumour
Endometriosis in the bladder (cursors). Arrowheads mark
position of the uterus.
 Acute pelvic infection with a thick-walled tubo-ovarian
abscess (arrow) and free pus in the pouch of Douglas (arrowhead).
 (A) Adnexal cyst with one solid area and some fine internal
echoes suggestive of a serous cystadenocarcinoma.
(B) Malignant adnexal cyst : Internal echoes and irregularly thickened
wall (arrowhead)
Solid tumour mass (white arrowheads) surrounding the
posterior aspect of the uterus (black arrows).
 Benign mucinous cystadenoma showing the typical
multiloculated appearance-impossible to differentiate from a
malignant tumour
Ovarian fibroma. Homogeneous solid mass (arrows)
arising from the ovary (arrowheads).
 Typical dermoid : Floating echogenic area with
acoustic shadowing due to fat fulid level, with or without calcification.
(B) Dermoid cyst: Note the echogenic
nodule (arrows) and dense acoustic shadowing (arrowheads).
Solid ovarian mass with a thickened endometrium
(arrowheads) in a postmenopausal patient
 (A) Solid-appearing dermoid cyst. Note the thick septum
and two nodules (arrows and arrowheads) casting shadows.
(B) Echogenic dermoid cyst (arrows). Note how the mass mimics a loop of
bowel. The remainder of the ovary (arrowheads) is seen.
 Bilateral adnexal masses due to ovarian metastases. Note
predominantly cystic mass on the right and partly solid mass on the
left.
(A) Metastatic ovarian carcinoma causing omental thickening
(B) Metastatic ovarian carcinoma : serosal tumour
(arrowheads) around a loop of bowel (arrow).
 Gbran malignancy ovarii
• Hipoechoic solid area within the mass (highly
echogenic solid area due to far or calcification are
typical of dermoids).
• Nodular septasi tebal >3 mm
• Ukuran massa > 7 cm (lesi kistik > 7 cm benign
• Central lbh hipervasc dibanding perifer
• RI less than 0.6 (Fig. 34.57). RI greater than 0.8 is
suggestive of benign disease but there is an
indeterminate range of 0.6-0.8;
outlining the cavity and entering the fallopian tube (arrows).
outlines a fibroid polyp (arrows) in the uterin cavity
Dermoid cyst. Note calcification and teeth with a fat-fluid level
(Arrow)
Barium enemas. (A) Serosal metastases from ovarian carcinoma. (B)
Short smooth stricture due to endometriosis (arrowheads). Note the
puckering (lipatan) of the serosal surface due to adhesions (arrow).
 Venous intravasation. Myometrial plexus shown with drainage
into the ovarian veins (arrowheads). Peritoneal spill is also seen
 (A) bicornis bicollis. Note the completely separate
cervical canals and uterine horns, both of which have patent tubes
(B) Unicornis without rudimentary horn.
 A. Filling defect due to submucous fibroid
B. Distorsi cavum uteri dan tuba kanan oleh mural fibroid. Tampak small calcified
fibroid (arow)
C. Cavity enlarged by fibroids
Polypoid endometrium causing multiple filling defects (arrow)
Linier filling defek pd cavum uteri krn adesi
 Enlarged uterus with multiple diverticular-like projections
of contrast into the myometrium typical of adenomyosis
Severe Asherman's syndrome with complete oblitera tion of the uterine
cavity.
TB endometritis, cav uteri irreguler
 Large left hydrosalpinx. Note
the mucosal folds on the left have been obliterated and there is no
distal spill
Salpingitis isthmica nodosa (arrows). The left tube is very irregular and
beaded (bermanik2) and terminates (berakhir)in a hydrosalpinx
(arrowhead).
 (A) Uterus with low-density areas due to fibroids. One
small fleck of calcification.
(B) Adenomyosis: Massa inhomogen dg displacement cavum uteri ke
posterior
Simple adnexa cyst
Dermoid cyst (arrows). The mass is of mixed attenuation but contains
a large amount of fat. It has a calcified rim and a dense area of
calcification (arrowheads)= tooth
 Bilateral cystic adnexal masses. Note the tiny gas bubble
(arrow) seen in one of the masses. Bilateral hydrosalpinges with
chronic infection.
 Patient with ovarian carcinoma, peritoneal deposits (white
arrowheads), para-aortic lymphadenopathy (black arrowheads) and
' omental cake' (black arrows).
 Multiple leiomyomas T2 : a large cervical intramural leiomyoma (c) and smaller
intramural tumours (e). There is a degenerating serosa leiomyoma (d) and a smaller
serosal leiomyoma (s) adjacent to a loculated cystic collection = hydrosalphing (h)
 Endometrioma deposit (arrow) within the bladder wall on
(A) T1 (B)T2. Note the areas of high signal within the superficial
margin of the deposit due to haemorrhage in (A), and the low signal on the T2
 Endometriosis on a transverse image showing multiple fluid-fluid
levels (haemorrhagic contents within multiloculated cysts). There is
dilatation of the right ureter (arrow).
Diffuse adenomyosis on sagittal T2 - image showing diffuse irregular
low-signal thickening of the junctional zone. b = bladder.
Focal adenomyosis intramural (arrow) on (A) coronal and (B) sagittal T 2
images showing focal low-signal thickening of the junctional zone in (A)
undergoing haemorrhage (arrowed in B) a year later. b = bladder; e =
intramural leiomyoma
Cervical carcinoma (arrow) infiltrating into the bladder (b) with a separate
tumour nodule in the posterior fornix (arrowhead) on a sagittal T2 image.
Note the endometrial obstruction (e).
 Carcinoma of the cervix (stage 1132) showing exophytic tumour (arrows)
within the vaginal canal on sagittal T2. Note the intact low-signal vaginal wall.
b = bladder
 Staging Ca cervix
• FIGO TNM
• 0 In situ Tis
• I Confined to uterus TI
• IA Diagnosed only by microscopy Tl a
• Al Depth <_3 mm; width <7 mm Tl a1
• IA2 Depth >3-5 mm; width <7 mm TI a2
• IB Clinically visible or microscopy >IA2 T1b
• IBI Clinically <4 cm diameter TI lot
• 1132 Clinically >4 cm TI b2
• II Beyond cervix but not to pelvic wall T2
• IIA Involvement of vagina but not lower third T2a
• li t Parametrial extension but not to pelvic side-wall T2b
• Ill Extension to pelvic wall/lower third vagina/hydronephrosis T3
• IIIA Lower third vagina T3a
• IIIB Extension to pelvic wall/hydronephrosis T3b
• IV Extension beyond true pelvis/bladder/rectum T4
• IVA Involvement of bladder/rectum T4
• IVB Spread outside true pelvis/metastases to other organs M1
Bulky exophytic cervical carcinoma confined within the cervix on a sagittal T2. The low
signal vaginal wall remains intact apart from an area of tumour infiltration
posteriorly (arrow). Within the tumour in the anterior fornix there is an area
of necrosis. b = bladder
 Bulky carcinoma of the cervix extending into the body of the uterus,
lower third of the vagina (small arrows) and bladder (open arrow) on a
sagittal T2
 Carcinoma of the cervix (stage I I B) showing tumour (t)
within the parametrium (arrows) on transverse. Note the loss of the
normal low signal from the cervical stroma. b = bladder.
Tumour (t) infiltrating the parametrium and left iliacus muscle (i), with
left-sided involved lymph nodes (n) and a right ovarian metastasis (o)
on a transverse T2 , (b) bladder
 Cervical carcinoma (t) extending into the parametrium producing
left hydronephrosis (straight arrow) and extending posteriorly through the
perirectal fascia into the rectal mucosa (curved arrow) on T2
Carcinoma of the cervix (t) infiltrating through the bladder
wall (arrow) on a transverse T2
(TSE 5041/132) image. Note the low-signal vaginal wall (arrow). b =
bladder,
r =rectum
 Extensive recurrent cervical carcinoma (t) following a hysterectomy on (A) selected
transverse T 2, and (B) coronal T 2- fat-suppressed image. There is a large tumour
recurrence infiltrating through the lower two-thirds of the vagina into the pelvic floor
and in the bladder wall (open arrow), with separate tumour nodules in the right ischial
rectal fossa (straight arrow) and left parametrium. There is bilateral inguinal
lymphadenopathy (small arrows). Note the mass of higher signal than tumour in the
left adnexa
 Ca cervix (straight arrow) (A) before tx (B) 6 weeks (C) 6 months after radiotherapy.
Note the rapid reduction in size of the tumour between (A) and (B). The small area of
high signal in the cervix in (C) is due to either residual tumour or post-treatment
change. Note the low-signal area in the uterus due to a non-degenerating leiomyoma
(curved arrow), and the high mucosal signal in the posterior wall of the bladder (b)
from radiotherapy change in (B) and (C).
Endometrial carcinoma
Bilateral Cyst ovaries. a low signal haemorrhagic right ovarian cyst (large arrow-probably a
corpus luteum cyst) with some surrounding free intraperitoneal fluid (small arrow)
Multiloculated thin-walled haemorrhagic benign ovarian cysts (c) showing fluid-fluid
levels on a transverse T2. There is a coincidental uterine leiomyoma (I).
Large left adnexa mass (d) due to an ovarian dermoid displacing the uterus which
contains a coincident subserosal leiomyoma (I) on placing coronal T1 and (B)
transverse T2 images. The dermoid cyst has solid and cystic components
 Dermoid cyst (arrow). Unilocular mass with and (B) sagittal T2
image. A fat-suppressed sequence (not shown) was also performed to
confirm the fat content of the cyst
 Complex large left adnexal mass with solid and cystic components(arrows)
compressing and displacing the uterus on transverse T2 image. Note that there is
distension of the endometrial cavity with intermediate to high signal due to a
coexisting endometrial tumour (e). Endometrioid carcinoma of the ovary is associated
in approximately a third of cases with endometrioid carcinoma of the uterus.
 Mucinous cystadenoma Ca. roducing alarge mass, with mixed contents, filling the
pelvis on a transverse T2 weighted. The area of signal void within the tumour is due to
either blood products or mucin. (Courtesy of Dr J. M. Hawnaur, Department
. of Diagnostic Radiology, University of Manchester.) (B) Large right ovarian
inflammatory mass, proven actinomycosis (t) producing an obstructive uropathy
with dilatation of the right ureter (u) on a transverse T2 -weighted . Note the position
of the ureter to the adnexal