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.

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

NormalAnatomy

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Quickreviewof
normalanatomy!
Ovary
FallopianTube
Uterus
Cervix
VaginalCanal
BUTTHATSJUST
ADRAWING!!

CT of the Ovaries and Uterus

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)

CT of the Ovaries and Uterus

NormalAnatomy

R
Thisiswhatyoullsee:
anormalaxialpelvicCT.

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries
Fallopian
Tubes
Uterus
Cervix
VaginalCanal
Eachimageisavisualslicethroughthepelvis

CT of the Ovaries and Uterus

NormalAnatomy

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries
Fallopian
Tubes
Uterus
Cervix
VaginalCanal
Whichbasicallyyieldsa
radiographicvisualization
ofpelvicanatomy.

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

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.

CT of the Ovaries and Uterus

The Approach

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

During the Lifecourse and Pathologies

parts of this presentation we will use a
repetitive 3-slide approach to each CT image.

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!

CT of the Ovaries and Uterus

The Approach

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

A quick CT terminology reference:

(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)

Fat Attenuation (fat density - same density as fat on CT)

Fluid attenuation (same density as fluid on CT - kind of nonspecific - better to say
blood attenuation[a little denser than average fluid due to cellular contents] or water
attenuation[a little less dense than average fluid due to lack of cellular or proteinaceous
content])
Soft-tissue attenuation (same density as muscle on CT)
Bone attenuation (same density as bone on CT)

Contents: Heterogeneous v. Homogenous

Wall: Thin-walled v. Thick-walled
Border: Well-circumscribed v. Indistinct Borders
Internal borders: Septated
External Contour: Smooth v. Lobulated (lobed)
Path: Tortuous (serpiginous)
Size: enlarged v. atrophied
Contrast: enhancing (lights up with contrast) v. non-enhancing (doesnt)
Location

Absolute - in the cervical canal

Relative - posterior to the left ovary, medial to the right sacral wing

NormalAnatomicChangeOverthe
FemaleLifecourse

CT of the Ovaries and Uterus

NormalAnatomicChange
OvertheFemaleLifecourse

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Becausetheovariesanduterusarepartof
thereproductivesystem,theirfunction
changesastheindividualmaturesandages.
Functionalchangesarereflectedinthe
anatomyasvisualizedbyCT.

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

NormalAnatomicChange
OvertheFemaleLifecourse
33yearold

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Lifecoursecase2a

Describewhatyousee.
Again,hereiswhereyoushouldsay,Isee
alargersofttissuedensityuterinetissuein
themidpelviswithsomeregionsof
hyperdensityetcandsoforth

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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!)

CT of the Ovaries and Uterus

NormalAnatomicChange
OvertheFemaleLifecourse

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Lifecoursecase3a

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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!)

CT of the Ovaries and Uterus

NormalAnatomicChange
OvertheFemaleLifecourse
27yearold

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Lifecoursecase4a

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

NormalAnatomicChange
OvertheFemaleLifecourse

66yearold

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Lifecoursecase5a

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

ExamplePathologies
Nonneoplasm
Ovarian/tubal
- Uterine
- Pregnancyassociated

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Neoplasm
Ovarian
Uterine
Cervical

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase1a:
Describewhatyousee.
(Ignorethearrows,
theyreshowingbowel
inflammationofCrohns
Disease.)

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase2a:
Describewhatyou
see.

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase2b:
SampleDescription:
enlargeduterusofsofttissue
attenuation,flankedatthe
posterioraspectsbytortuous,
thickwalledoviductsfilledwith
materialoffluidattenuation.

Whatarepossible
pathologies?

CT of the Ovaries and Uterus

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,

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase3a:
Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase3c:
TuboovarianAbscess

Tuboovarianabscess

Lovary

::sequelaeofPID
::inadnexalregion
::thickwalledfrom
inflammation
::fluiddensityregions
::internalseptation

CT of the Ovaries and Uterus

PathologyNonneoplasm

Thisisahardone!!!

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Ovaries/Tubescase4a:
Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Uteruscase1a:
Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Pregnancyrelatedcase1a:

Description.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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.

CT of the Ovaries and Uterus

PathologyNonneoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

Pregnancyrelatedcase2a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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!

CT of the Ovaries and Uterus

PathologyNeoplasm
Clue:thisarisesfromleftovaryina13yearold

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

OvarianNeoplasmcase1a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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!

CT of the Ovaries and Uterus

PathologyNeoplasm
Clue:thisarisesfromtheovary

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

OvarianNeoplasmcase2a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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%)

CT of the Ovaries and Uterus

PathologyNeoplasm
Clue:Thisarisesfromtheovary

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

OvarianNeoplasmcase3a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNeoplasm
Clue:Thisarisesfromtheovary

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

OvarianNeoplasmcase4a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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).

CT of the Ovaries and Uterus

PathologyNeoplasm

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

UterineNeoplasmcase1a:

Describewhatyou
see

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

PathologyNeoplasm
Clue:Thisarisescaudaltotheuterus

Normal Anatomy
Anatomic Change Over the
Lifecourse

Example Pathologies

Non-neoplasm

Neoplasms

CervicalNeoplasmcase1a:

Describewhatyou
see.

CT of the Ovaries and Uterus

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?

CT of the Ovaries and Uterus

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

CT of the Ovaries and Uterus

Sources

SiddallKA.MultidetectorCTofthefemalepelvis.RadiolClinNorthAm.01NOV2005;43(6):
1097118
CasillasJ,JosephRC,GuerraJJJr.CTappearanceofuterineleiomyomas.Radiographics.1990
Nov;10(6):9991007.
FoshagerMC,WalshJW.CTanatomyofthefemalepelvis:asecondlook.Radiographics.1994
Jan;14(1):5164;
OutwaterEK,SiegelmanES,HuntJL.Ovarianteratomas:tumortypesandimagingcharacteristics.
Radiographics.2001MarApr;21(2):47590.
Pannu,HK,etal.MDCTEvaluationofCervicalCancer:SpectrumofDisease.Radiographics2001;
21:11551168
RhaSE,etal.CTandMRimagingfeaturesofadnexaltorsion.Radiographics.2002Mar
Apr;22(2):28394.
RobertsJL,DalenK,BosankoCM,JafirSZ.CTinabdominalandpelvictrauma.Radiographics.
1993Jul;13(4):73552.
Roobolamini,SA.ImagingofPregnancyrelatedComplications.Radiographics1993;13:753770.
SaksoukFA,JohnsonSC.RecognitionoftheovariesandovarianoriginofpelvicmasseswithCT.
Radiographics.2004Oct;24Suppl1:S13346.
SamJW,JacobsJE,BirnbaumBA.SpectrumofCTfindingsinacutepyogenicpelvicinflammatory
disease.Radiographics.2002NovDec;22(6):132734.
YangDM.Retroperitonealcysticmasses:CT,clinical,andpathologicfindingsandliteraturereview.
Radiographics.2004SepOct;24(5):135365.
Buy,JN,etal.CysticTeratomaoftheOvary:CTDetection.Radiology1989;171:697701

Mt.Hood

Thatsit.Thatisasfarasweregoingthistime.
Theresmoreclimbahead,butyoucanblazeyourown
path.