Diagnostics and Diseases of the Female Reproductive Tract Kristin Joudrey June 28, 2010

Outline Radiographic and U/S techniques Ovaries Uterus Cystic Ovaries Ovarian Tumors Uterus Pregnancies Fetal development Dystocia Pyometra

Normal Ovaries Not seen on rads! Location: Caudal to respective kidneys U/S: 1.5cm x 0.7cm x 0.5cm Homogeneous parenchyma Cortex-contained follicles Indications Monitoring the estrus cycle Reproductive disorders (cysts, tumors)

Cystic Ovaries (Follicular Cysts) Cause: prolonged secretion of estrogen and attractiveness to males Prolonged Estrus +/- Proestrus Ovulation may not occur- abnormal estrous cycle #1 DDx: Ovarian granulosa cell tumor Tx: OHE Further diagnostics: Vaginal cytology (cornified cells?)

Cystic Ovaries Anechoic Well demarcated Round to irregular structure

Ovarian Tumors Varying echogenicity Well demarcated from surrounding tissue +/- compromised internal architecture Uni or Bilateral Generally, are rare Transverse image of Ovarian adenocarcinoma (R ovary), ventral and caudal to kidney. http://www3.interscience.wiley.com/cgi-bin/fulltext/119132682/PDFSTART

The Normal Uterus Not visualized on rads! Location: between descending colon and urinary bladder Various size ranges: Cervix: 1.5-2.2cm x 0.8cm Uterine horns: 10-14cm x 0.5-1.0cm Uterine body: 1.4-3cm x 3cm U/S: Homogenous, soft tissue opacity, relatively hypoechoic

The Uterus Why perform survey radiology? Confirming an enlarged uterus Fetal skeletons Monitor progression of uterine size (pregnancy, disease) Fetal viability

Preparation when radiographing 1.Withold the food for 24 hours 2.Evacuate the colon (enema) atleast 2 hours in advance 3.Proper technique!! 4.Abdominal compression (“spoon”) test

Vaginocystourethrogram (VCU) Indications: Pelvic/vaginal mass Dysuria Hematuria Incontinence Urethral stricture Urethral tumor Courtesy of Dr. R. Lofstedt

VCU Procedure 1.Do under G/A, lateral view 2.Water soluble organic iodide contrast media 3.Balloon-tipped catheter Insert into vestibule Inflate to occlude outflow of contrast (may need to clamp lips of vulva – do not leave clamps on longer than 15 minutes) 4.Use 10-15 mL (dogs) or 5-10mL (cats) or as needed to distend 5.Take rads when injecting last 2-3 mL 6.Filling: Vagina first, urethra, bladder

VCU rads Courtesy of Dr. Pack When positioning, pull the limbs forward: You don’t want the femurs superimposing over the urethra!

A cool discovery made on VCU!

Uteromegaly Radiographic findings: Coiled tubular structure extending caudally into the pelvic canal Cranial and dorsal displacement of SI and colon Body betw. colon and bladder

Uteromegaly Q: What are the 3 main differentials? A: Pregnancy The ‘metras’ Gravid/Post-partum uterus

Pregnancy Detection Radiographs Day 42-45: Fetal skeleton becomes opaque (mineralization)  50+ days: Fetus count, estimate size and position of fetuses Bones become visible at different times  The mandible is the last bone to mineralize

Pregnancy Detection Ultrasound: Most accurate 17-20 days: Gestational sacs (blastocysts) Anechoic with hyperechoic contained areas Confirms pregnancy  23-25+ days: Fetal heartbeat   34-36 days: Fetal movement (Yeager et. al. AJVR 53, 1992)

U/S Canine pregnancy at 25 days:

U/S Canine pregnancy at 30 days:

Click on the video!

Disturbances in fetal development

3 Fetal Death signs 1. Collapse of fetal skull bones 2. Intra- or peri- fetal gas accumulation   3. Abnormal fetal posture such as increased extension of the fetal limbs

How many feti can you see?

Dystocia: When should it be considered? 1) History of previous dystocia 2) Total parturition time >24 hr after a drop in rectal temp. to 37.7°C 3) Abdominal contractions>1-2h 4) Active labor lasting for >1-2h 5) Resting period during active labor >4-6 hr 6) Bitch or queen in obvious pain 7) Abnormal vulvar discharge

Dystocia Radiographs: Good for assessing… Size relationship between fetus and maternal pelvic canal. Fetal positioning relative to maternal pelvic canal Need for C-section Retained fetus

When should you intervene? After the onset of 2nd stage (uterine and abdominal contractions)… >3-4 hours: 1st pup >30min-1h (2-3h can be acceptable): subsequent pups Avg completion of 2nd stage: 6hs *Remember when doing preg checks: Stenosis of pelvic canal? Check for old pelvic fractures! Assess fetal viability

Pyometra The ‘-metras’ are usually well visualized on U/S lumen contains lots of fluid Echogenicity of uterine contents ranges: anechoic, “textured” or hyperechoic “sprinkles” # of cells in the lumen will not always correlate with a certain echogenicity

Pyometra

Pyometra

Questions?