Imaging of Gynecological Disorders in Infants and Children PDF
Preview Imaging of Gynecological Disorders in Infants and Children
Medical Radiology Diagnostic Imaging Series Editors Albert L. Baert Maximilian F. Reiser Hedvig Hricak Michael Knauth Editorial Board Andy Adam, London Fred Avni, Brussels Richard L. Baron, Chicago Carlo Bartolozzi, Pisa George S. Bisset, Durham A. Mark Davies, Birmingham William P. Dillon, San Francisco D. David Dershaw, New York Sam Sanjiv Gambhir, Stanford Nicolas Grenier, Bordeaux Gertraud Heinz-Peer, Vienna Robert Hermans, Leuven Hans-Ulrich Kauczor, Heidelberg Theresa McLoud, Boston Konstantin Nikolaou, Munich Caroline Reinhold, Montreal Donald Resnick, San Diego Rüdiger Schulz-Wendtland, Erlangen Stephen Solomon, New York Richard D. White, Columbus For furthervolumes: http://www.springer.com/series/4354 Gurdeep S. Mann Joanne C. Blair • Anne S. Garden Editors Imaging of Gynecological Disorders in Infants and Children Foreword by Albert L. Baert 123 Dr. Gurdeep S.Mann MD Prof.AnneS.Garden MD Department of PaediatricRadiology Department ofPaediatric Gynaecology AlderHey Children’sHospital AlderHeyChildren’s Hospital EatonRoad EatonRoad Liverpool Liverpool L122AP L122AP UK UK Dr. JoanneC. BlairMD and Department of PaediatricEndocrinology AlderHey Children’sHospital Lancaster Medical School EatonRoad Lancaster University Liverpool Lancaster L122AP LA14YB UK UK ISSN 0942-5373 ISBN 978-3-540-85601-6 e-ISBN978-3-540-85602-3 DOI 10.1007/978-3-540-85602-3 SpringerHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2011944259 (cid:2)Springer-VerlagBerlinHeidelberg2012 Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerialis concerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,broadcasting, reproductiononmicrofilmorinanyotherway,andstorageindatabanks.Duplicationofthispublication orpartsthereofispermittedonlyundertheprovisionsoftheGermanCopyrightLawofSeptember9, 1965,initscurrentversion,andpermissionforusemustalwaysbeobtainedfromSpringer.Violationsare liabletoprosecutionundertheGermanCopyrightLaw. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protectivelawsandregulationsandthereforefreeforgeneraluse. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consultingtherelevantliterature. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Foreword Duringthepastdecadesthefieldofpediatricgynecologydevelopedrapidlydue to the new insights evolving from basic and translation research in this rather small but less well known medical field. This volume of the Medical Radiology series is focused on the highly important imaging features, which are essential for a better understanding, diagnosis and treatment of gynecological disorders in infants and children. It fills a small but very specific gap in publications on modern medical imaging. The editors have been very successful in bringing together the considerable expertise of well acknowledged specialists from various disciplines such as pediatric radiology, gynecology, surgery and endocrinology, The result is a comprehensive review of our actual knowledge of gynecological imaging in infancy, childhood and adolescence. On the basis of the embryological devel- opment, normal childhood appearances as well as pubertal changes of the female genital tract are described in detail. This morphological introduction is followed by different chapters based on dominant symptoms. This innovative general structure of the book greatly benefits the the process of differential diagnosisforthereaderanditmakestheworkanexcellenttoolfordailyclinical practice. Numerous superb illustrations complete the text. This volume will undoubtedly become the reference work for every medical doctor, who wants to update her/his knowledge and skills in the area of gynecological disorders in infants and children. It is especially warmly recom- mended to pediatricians and radiologists. Prof. Albert L. Baert v Preface Thisinnovativetextbookofdiagnosticimaginginpaediatricgynaecologyis,to our knowledge, the first textbook to address this important and rapidly developing field of paediatric practice. Successful delivery of a paediatric gynaecology service requires close multi-disciplinary collaboration between expert paediatric gynaecologists, paediatric surgeons and urologists, endocri- nologistsandradiologists.Thisfieldofexpertiseisreflectedintheauthorshipof this text. Interpretation of clinical information and imaging requires a robust under- standing of the physiology of the female reproductive tract. It has therefore been our intention to describe the imaging of the female reproductive tract in the context of normal development from fetal life, through infancy, childhood and adolescence to the development of full adult maturity. We hope we have achieved this by committing two chapters to detailed descriptions of normal development: the first describing the embryology of the female reproductive tract and the second describing normal postnatal development, with a detailed description of the endocrinology that regulates these developmental changes. Fromthesedescriptionsofnormalanatomicaldevelopmentandmaturationwe have moved on to describe congenital, structural abnormalities, including dis- orders of sexual development and abnormalities in the timing of puberty. Gynaecologicalneoplasiaisaddressedinaseparatechapterandweincludetwo chaptersexploringtheassessmentofpelvicpainanddisordersofmenstruation. Finally, disorders of the breast are covered in our closing chapter. This textbook is intended primarily for paediatric radiologists, however it should be of interest to all those who care for girls with developmental or acquired gynaecological pathology, including radiologists, gynaecologists, urologists, endocrinologists, neonatologists and paediatricians. Wearemostgratefultoourcolleaguesfortheirsharingtheirexpertiseinthe developmentofthistextbook.Wehopeitwillbecomeareferenceandworking resource for all those who work in this fascinating field of medicine. Liverpool Gurdeep S. Mann Joanne C. Blair Anne S. Garden vii Contents Diagnostic Imaging Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Gurdeep S. Mann and Umber Agarwal Embryology of the Female Reproductive Tract . . . . . . . . . . . . . . . . . . 21 Andrew Healey Disorders of Sex Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Justin H. Davies, Pat S. Malone, and Jo Fairhurst Gynaecological Disorders in the Neonate and Young Child. . . . . . . . . . 51 Gurdeep S. Mann and Angela T. Byrne Structural Abnormalities of the Female Reproductive Tract. . . . . . . . . 65 Paul Humphries Normal Growth and Puberty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Caren J. Landes and Joanne C. Blair Delayed and Precocious Puberty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Laurence J. Abernethy, Joanne C. Blair, Julie B. Smith, and Mohammed A. Didi Menstrual Disorders and Vaginal Discharge. . . . . . . . . . . . . . . . . . . . . 145 Urmi Das and Gurdeep S. Mann Gynaecological Causes of Pelvic Pain. . . . . . . . . . . . . . . . . . . . . . . . . . 173 Gurdeep S. Mann, Angela T. Byrne, and Anne S. Garden Gynaecological Neoplasia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Kieran McHugh, Kirsteen McDonald, and Edwin Jesudason Breast Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Gurdeep S. Mann, Asha Shivaram, and Andrew Healey Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 ix Contributors LaurenceAbernethyDepartmentofRadiology,AlderHeyChildren’sHospital NHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: laurence. [email protected] Umber Agarwal Department of Fetal and Maternal Medicine, Liverpool Women’s Hospital NHS Foundation Trust, Liverpool, L8 7SS, UK, e-mail: [email protected] JoanneC.BlairDepartment ofEndocrinology,AlderHeyChildren’sHospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK, e-mail: [email protected] AngelaByrneDepartmentofRadiology,BritishColumbiaChildren’sHospital, University of British Columbia, Vancouver, BC, V6H 3V5, Canada Urmi Das Department of Endocrinology, Alder Hey Children’s Hospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK, e-mail: urmi.das@ alderhey.nhs.uk Justin Davies Department of Paediatric Endocrinology, Child Health Direc- torate, Southampton University Hospital Trust, Southampton, SO16 6YD, UK, e-mail: [email protected] Mohammed Didi Department of Endocrinology, Alder Hey Children’s Hos- pital NHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: mohammed. [email protected] Jo Fairhurst Department of Radiology, Southampton University Hospital Trust, Southampton, SO16 6YD, UK, e-mail: [email protected] Anne S. Garden Department of Gynaecology, Alder Hey Children’s Hospital NHSFoundationTrust,Liverpool,L122AP,UK,e-mail:a.garden@lancaster. ac.uk AndrewHealeyDepartmentofRadiology,AlderHeyChildren’sHospitalNHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: andrew.healey@ alderhey.nhs.uk Paul Humphries Imaging Department, University College Hospital, London, NW1 2BU, UK, e-mail: [email protected] xi xii Contributors EdwinJesudasanDepartmentofSurgery,AlderHeyChildren’sHospitalNHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: Edwin.jesudason2@ alderhey.nhs.uk Caren Landes Department of Radiology, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: caren.landes@ alderhey.nhs.uk KirsteenMcDonaldRadiologyDepartment,GreatOrmondStreetHospitalfor Children NHS Trust, London, WC1N 3JH, UK,e-mail: kmcdonald@doctors. org.uk Pat Malone Department of Urology, Southampton University Hospital Trust, Southampton, SO16 6YD, UK, e-mail: [email protected] Gurdeep S. Mann Department of Radiology, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: gurdeep.mann@ alderhey.nhs.uk Kieran McHugh Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK, e-mail: MCHUGK@gosh. nhs.uk Asha Shivaram Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, UK, e-mail: asha. [email protected] Julie Smith Department of Radiology, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, L12 2AP, UK, e-mail: julie.smith@ alderhey.nhs.uk Diagnostic Imaging Techniques Gurdeep S. Mann and Umber Agarwal Contents 5 ContrastStudies..................................................... 11 5.1 Genitography........................................................... 11 5.2 Vaginography........................................................... 13 1 Introduction............................................................ 2 5.3 Cystography............................................................. 13 2 SpecialConsiderationsandtheImaging 6 ComputedTomography........................................ 13 Environment,SedationandAnaesthesia............ 3 6.1 Indications................................................................ 13 2.1 SpecialConsiderations............................................ 3 6.2 CTParameters......................................................... 13 2.2 SedationandAnaesthesia........................................ 3 6.3 IntravenousContrastMedium................................. 13 6.4 BowelContrast........................................................ 14 3 UltrasoundandDoppler....................................... 3 6.5 Post-processing........................................................ 15 3.1 Indications................................................................ 4 3.2 TransabdominalUSImaging.................................. 4 7 Radiography........................................................... 15 3.3 DopplerUS.............................................................. 6 7.1 BonyandSpinalAbnormalities.............................. 15 3.4 TransperinealUS..................................................... 6 7.2 SoftTissueCalcifications....................................... 15 3.5 TransvaginalUS...................................................... 7 7.3 Radio-OpaqueForeignBodies................................ 16 3.6 TransrectalUS......................................................... 7 8 Drainage,BiopsyandAngiography.................... 16 4 MagneticResonanceImaging.............................. 8 8.1 DrainageandAspirationProcedures...................... 16 4.1 Indications................................................................ 8 8.2 Biopsies.................................................................... 17 4.2 FieldStrength.......................................................... 8 8.3 Angiography............................................................ 17 4.3 PatientPreparation................................................... 8 9 AntenatalImaging................................................. 17 4.4 PatientPosition........................................................ 8 4.5 Free-BreathingandBreath-HoldImaging.............. 8 References.......................................................................... 18 4.6 SpasmolyticAgents................................................. 8 4.7 Coils......................................................................... 8 4.8 ScanningPlanes....................................................... 9 Abstract 4.9 PulseSequences....................................................... 10 Imaging of the paediatric gynaecological tract encompassespatientswithvastlydifferentphysiol- ogy ranging from the neonate under maternal hormonal influence to the post-pubertal young G.S.Mann(&) adolescent. Ultrasound is the mainstay of imaging DepartmentofPaediatricRadiology,AlderHey of the genitourinary tract. In specific clinical Children’sHospitalNHSFoundationTrust,Liverpool,UK circumstances, cross-sectional imaging may be e-mail:[email protected] necessary.Magneticresonanceimaging(MRI)with G.S.Mann itsintrinsichighsofttissuecontrastandmultiplanar DepartmentofRadiology,LiverpoolWomen’sHospital capability is preferred but will usually necessitate NHSFoundationTrust,Liverpool,UK some of form of sedation in the younger child. U.Agarwal Computed tomography (CT) is preferably avoided Maternal-FetalMedicine,DepartmentofObstetricsand because of ionising radiation exposure. Contrast Gynaecology,LiverpoolWomen’sHospitalNHS FoundationTrust,Liverpool,UK G.Mannetal.(eds.),ImagingofGynecologicalDisordersinInfantsandChildren,MedicalRadiology. 1 DiagnosticImaging,DOI:10.1007/174_2010_80,(cid:2)Springer-VerlagBerlinHeidelberg2012
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