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

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

3. 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)

4. 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?)

5. Cystic Ovaries
Anechoic
Well demarcated
Round to irregular structure

6. 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.

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

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

9. 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

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

11. 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 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

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

13. A cool discovery made on VCU!

14. 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

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

16. 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

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

18. U/S
Canine pregnancy at 25 days:

19. U/S
Canine pregnancy at 30 days:

20. Click on the video!

21. Disturbances in fetal development

22. 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

23. How many feti can you see?

24. 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

25. 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

26. 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

27. 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

28. Pyometra

29. Pyometra

30. Questions?