课件：妇产科疾病的超声诊断.ppt

Ultrasonography on Gynecology and Obstetrics,Sangreal-uterus,THE DA,WINCI CODE,Pelvic Cavity Posterior : Occupied by rectum, colon, and ileum Anterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vagina,NORMAL ANATOMY,Pre-inspection :,Moderate bladder filling,Uterus,Hollow, pear-shaped organ Divided into fundus, body, and cervix Usually anteflexed and anteverted Covered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladder Supported by levator ani muscles and pelvic fascia Round ligament keeps uterus in position,Uterine size,Prepubertal : 3 cm long by 0.5 to 1.0 cm wide Menarcheal: 8 cm long by 4 cm wide Postmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wide Normal size : 23(thick)45(width)78 cm(length),Uterine longitudinal diameter,Uterine wide diameter,Uterus before and after the Trail,length 78cm,before and after the Trail 23cm,width 45cm,Uterine Position,Midline anteversion: most common; degree of anteversion is bladder distention dependent Right or left: normal variant in absence of pelvic masses Retroverted: entire organ displaced posteriorly Retroflexed: body displaced with respect to cervix,Ultrasonography of normal uterus,Uterine serosa layer: Linear high-echo ;clear, smooth; Myometrium: Homogeneous middle-echo ; Endometria: The middle line of high echo , around the weak echo . It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.,Uterine serosa layer,Myometrium,Endometria,Normal uterus transabdominal ultrasonography,Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through the middle of the uterine cavity.,Myometrium,Endometria,Uterine serosa layer,Fallopian Tube（输卵管）,Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovaries Ampulla: sidest part of the tube where fertilization occurs Isthmus: hardest part; lies just lateral to the uterus Length: 12 cm; supplied by ovarion arteries and veins,Ovary（卵 巢）,Almond shaped Attached to back of the broad ligament by mesovarium; sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and obturator nerve Receives blood from ovarian artery Blood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal vein,Sonography of the normal ovary,An ovoid homogeneous echodensity; follicular cysts are often present. The best sonographic marker for the ovary is identification of a follicular cyst, which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.,Transabdominal sagittal image shows the left ovary posterior to the urinary bladder,Transvaginal sagittal image of the ovary,ovarian follicle,Follicular wall flow,Common Diseases of Obstetrics and Gynecology,Gynecology ：Leiomyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc. Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.,The uterus Leiomyoma /Hysteromyoma,Characteristics of Leiomyomas,Most common pelvic tumor Smooth muscle cell composition Fibrosis occurs after atrophic of degenerative changes Degeneration occurs when fibroids outstrip their blood supply; calcification May be pedunculated Clinical: enlarged uterus, profuse and prolonged bleeding, pain,Uterine Locations of leiomyomas,Submucosal Erode into endomertial cavity heavy bleeding; infertility Intramural May enlarge to cause pressure on adjacent organs; infertility Subserosal May enlarge to cause pressure on adjacent organs,Subserous myoma,Broad ligament myoma,Cervical myoma,intramurous myoma,Submucous myoma,Ultrasonic performance,Two-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the uterine body ，Rear echo attenuation； With calcification or Cystic change, etc；Signs of oppression； Color Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ； Doppler spectrum：Medium resistance index，RI 0.60.1。,intramurous myoma,Subserous myoma,intramurous myoma,Subserous myoma,Cervical myoma,Abundant tumor blood flow,M,UT,RI 0.61,Submucous myoma with calcification,Teratoma Dermoid Tummors （卵巢良性囊性畸胎瘤/皮样囊肿),Pathology ：derives from germ cell，the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to 20% are bilateral. About 80% occur in women of childbearing age.,Size ranges from small to 40 cm Unliateral,round to oval mass Contains faty,sebaceous material, hair, cartilage, bone, teeth Clinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsion Sonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowing,Special Ultrasound Findings:,1. A cystic mass: with an echogenic mural nodule 2. A paste sign：particulate liptinite 3. A fluff of hair sign 4. A fat-fluid level sign：with fluid level in the cyst, fat above, fluid below. 5. A complex mass,cystic teratoma of ovary,A cystic mass,Paste sign,Fluff of hair sign,Paste sign,Fat-fluid level sign,A complex mass,A 8 years old girl, cutting off a three kilograms benign teratoma,The role of Ultrasound in Obstetrics,TRIMESTERS,First trimester = 0 to 12 weeks of gestation Second trimester = 13 to 26 weeks of gestation Third trimester = 27 to 42 weeks of getsation Postterm pregnancy = 42 weeks of gestation,Indications for First-Trimester Sonography,Confirm presence of intrauterine pregnancy Evaluate for suspected ectopic pregnancy Define cause of vaginal bleeding Determine gestational age Confirm suspected multiple gestations Aid in invasive procedures Evaluate pelvic masses Detect uterine abnormalities,Natural pregnancy,Nonage pregnancy (First-Trimester),Definition ：Pregnancy before 12 weekend.,5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ; 7-8 Weeks Primitive heart tube pulse； 8-11 weeks Yolk sac; 9 weeks Embryonic, placenta.,The Normal First Trimester,Sonographic Features of a Normal Gestational Sac,Shape: round of oval Position: fundal or middle portion of uterus; a center position relative to endometrium Contour: smooth Wall: echogenic; 3 mm of more in thickness,Internal landmarks: yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mm Growth: 1 mm per day (range: 0.7 mm to 1.5 mm per day),4-5 weeks pregnant In the gestational sac we can see a embryo point, the earliest embryo.,7 weeks pregnant Fetus was about 4 mm，we can see apparent heart throb, and small limb bud .,8 weeks pregnant Three-dimensional ultrasound show its beginning of the shape of a human.,Umbilical bord,Embryonic head,Embryonic abdomen,Yolk sac,Embronic head,Amniotic sac,9 weeks pregnant Known as a fetal，Development of the various parts of the fetus, tends to improve.,12 weeks pregnant The spine is identifiable , as the two bead-like high echo. Ears, limbs, bones can be shown and measurement.,Ultrasound of the Second and Third Trimesters,Indications for Second- and Third-Trimester,Estimate gestational age for patients with uncertain dates Evaluate uterine size and clinical date discrepancies Evaluate fetal growth Estimate fetal weight Determine fetal presentation Evaluate fetal life,provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placement Evaluate uterine abnormality Evaluate abnoumal maternal serum alpha-fetoprotein values Evaluate abnormal amniotic fluid Evaluate placenta Etc.,The Second- and Third-Trimester ( Metaphase and terminal prengancy),Mid-pregnancy:13-27 weeks pregnancy. Late-pregnancy:More than 28 weeks of pregnancy.,Scanning Techniques,Survey uterus Observe cardiac activity Determine position and number of the fetus and placenta Assess amniotic fluid Look for uterine of placental masses and fetal anomalies,Check contents,1、Fetal head ：BPD biparietal diameter; 2、Fetal abdomen: AC abdomen circumference; 3、Fetal limb： FL femur length ; 4、Others：Placenta, Fetal heart rate, Amniotic fluid, etc.,1 、 Fetal head,Measuring the Biparietal Diameter(BPD) Obitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nuclei Make sure the head is symmetric and oval Measure from outer to inner margins of the skull In the third trimester, the BPD is not as accurate in predicting fetal age,Fetal head, after 12 weekend pregnant,Fetal side profile, we can observe its forehead, nose ,lip, and chin, etc.,2、Fetal abdomen,The hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ducts The gastrointestinal system: the esophagus, stomach, small and large intestines(colon),The urinary system: kidneys, adrenal glands, ureters, bladder. The fetal abdomen circumference（AC) is the most widely measured,Measuring the Abdominal Circumference(AC),The AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liver The outer margin of the abdominal wall should be measured The abdominal wall measurement is the least accurate,The fetal liver,gallbladder,stomach,port venous,spine,gallbladder,stomach,3、Fetal limbs,The upper limbs: the ulna the radius the humerus The lower limbs: the femur/the thigh bone the fibula the tibia The femur is the most widely measured long bone （FL femur length ）,Femur measurement,Hyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condyles The mormal femur has a straight laeral border and a curved medial border Femur length may be used with the same accuracy as BPD to predict gestational age Femur length may indicate skeletal dysplasias or intrauterine growth restriction,Long