Obstetric and Gynecologic Ultrasound: Case Review Series E-Book , livre ebook

Series Editor
David M. Yousem, MD, MBA
Professor of Radiology Director of Neuroradiology Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland

Other Volumes in the CASE REVIEW Series
Brain Imaging, Second Edition
Breast Imaging, Second Edition
Cardiac Imaging
Duke Review of MRI Principles
Emergency Radiology
Gastrointestinal Imaging, Third Edition
General and Vascular Ultrasound, Second Edition
Genitourinary Imaging, Second Edition
Musculoskeletal Imaging, Second Edition
Nuclear Medicine, Second Edition
Pediatric Imaging, Second Edition
Spine Imaging, Second Edition
Thoracic Imaging, Second Edition
Vascular and Interventional Imaging
CASE REVIEW

Obstetric and Gynecologic Ultrasound

THIRD EDITION
CASE REVIEW SERIES

Karen L. Reuter, MD, FACR
Professor of Radiology Tufts University School of Medicine Section Head Lahey Clinic Medical Center Burlington, Massachusetts

John P. McGahan, MD, FACR
Professor and Vice Chair of Academic Affairs Director of Abdominal Imaging University of California, Davis Health System Sacramento, California
1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899

OBSTETRIC AND GYNECOLOGIC ULTRASOUND:
CASE REVIEW, THIRD EDITION ISBN: 978-1-4557-4375-9
Copyright 2013 by Saunders, an imprint of Elsevier Inc.
Copyright 2007, 2001 by Mosby, an affiliate of Elsevier Inc.

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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Reuter, Karen L.
Obstetric and gynecologic ultrasound : case review/Karen L. Reuter, John P. McGahan. -- 3rd ed.
p. ; cm. -- (Case review series)
Rev. ed. of: Case review. 2nd ed. c2007.
Includes bibliographical references and indexes.
ISBN 978-1-4557-4375-9 (pbk. : alk. paper)
I. McGahan, John P. II. Reuter, Karen L. Case review. III. Title. IV. Series: Case review series.
[DNLM: 1. Genital Diseases, Female--ultrasonography--Examination Questions. 2. Fetal Diseases--ultrasonography--Examination Questions. 3. Pregnancy Complications--ultrasonography--Examination Questions. 4. Ultrasonography--Examination Questions. 5. Ultrasonography, Prenatal--Examination Questions. WP 18.2]

618.107543--dc23
2012041503


Content Strategist: Don Scholz
Content Development Specialist: Gina Donato Publishing Services Manager: Patricia Tannian Design Direction: Steven Stave
To the radiology residents and all those who participate in the obstetric and gynecologic care of women
SERIES FOREWORD
I have been very gratified by the popularity and positive feedback that the authors of the Case Review series have received on the publication of the multiple editions of their volumes. While some are still in first editions, others have third editions printed and fourth editions in the works. This speaks to the high quality of the authors and the material they have at their disposal. At the same time, the online versions available at https://casereviewsonline.com/ offer new capabilities and interaction and self-guided learning that print editions cannot provide.

David M. Yousem, MD, MBA
BOOK FOREWORD
I congratulate Dr. Karen Reuter for spearheading the third edition of the Obstetric and Gynecologic Ultrasound: Case Review Series and for pulling in the experience of Dr. John McGahan, a noted educator and outstanding academician. I am happy to see the life span of this volume continue to grow in new ways with new technologies and new entities. I am sure that trainees and practicing radiologists will appreciate this contribution, as I do, to the Case Review Series . Bravo Karen and John!

David M. Yousem, MD, MBA
PREFACE
This updated third edition of the case review series not only focuses on ultrasound in obstetrics and gynecology but also emphasizes the growing use of MRI in both obstetric and gynecologic imaging. In most situations, ultrasound is definitive in either documenting normal findings or delineating a specific abnormality. However, in some cases, MRI is useful in collaboration with ultrasound in establishing a diagnosis or providing other information that may be definitive. This ultrasound case series is in a new format that includes the use of multiple choice questions with more detailed explanations and discussions including the most recent medical knowledge. We have provided new cases with updated materials and the latest reference publications and cross-references to the newest edition of Ultrasound: The REQUISITES . We hope you find these cases helpful in your understanding of ultrasound imaging of obstetric and gynecologic abnormalities for optimal patient care.

Karen L. Reuter, MD, FACR
John P. McGahan, MD, FACR

Because of space limitations, not all of the references have been included with each case in this book. Additional references are available at https://casereviewsonline.com/ .
ACKNOWLEDGMENTS
A special thank you to my husband, John; Kara and Elias, Kendra and Mark, Kristyn and Jacky (Tin Kei), and Sophia and her brother Sebastian for their loving support.
KLR
I would like to thank everyone who helped in preparation of this textbook. First and foremost, I d like to thank Teresa Victoria, MD, PhD, and Jeffrey C. Hellinger, MD, for supplying many of the magnetic resonance images that helped to make this text useful. Also, I would like to thank Alex Fodor, MD, Jonathan Kuo, MD, Liina Poder, MD, Simran Sekhon, MD, Holly Thompson, MD, and Luke Wright, MD, who prepared individual cases for this Case Reviews series. They certainly helped make this journey more enjoyable. Finally, I would like to thank those who helped me directly with either illustration preparation or text preparation including both Hue To and Julie Ostoich. Their hard work made my job much easier.
JPM
CONTENTS
Cover Page
Title Page
Copyright Page
Dedication Page
Series Foreword
Book Foreword
Preface
Acknowledgments
Opening Round
Fair Game
Challenge
Index of Cases
Index of Terms
Opening Round
CASE 1

History: A 61-year-old woman receiving long-term treatment with tamoxifen for breast cancer presents with endometrial thickness of 18 mm detected on a transvaginal sagittal image of the uterus.

1 . What spectrum of endometrial abnormalities does tamoxifen induce? (Choose all that apply.)
A. Polyps of the endometrium
B. Subendometrial cysts
C. Endometrial hyperplasia
D. Atrophy
2 . What is the effect of tamoxifen on the uterus?
A. Antiestrogenic
B. Estrogenic
C. Progesterogenic
3 . What is the normal thickness of the endometrium of the uterus in a patient receiving long-term tamoxifen treatment?
A. 10 mm or more
B. Less than 6 mm
C. 8 to 10 mm
4 . What is the most common endometrial pathology resulting from tamoxifen use?
A. Endometrial hyperplasia
B. Subendometrial cysts
C. Polyps

ANSWERS

CASE 1

Tamoxifen

1 . A, B, and C
2 . B
3 . B
4 . C

References
Cohen I: Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol . 2004; 96(2):256-266.
http://www.ncbi.nlm.nih.gov/pubmed/15297160 (Accessed on May 29, 2012.).
DeKroon CD, Louwe LA, Trimbos JB, et al. The clinical value of 3-dimensional saline infusion sonograph