妇产科疾病的超声诊断2011-ENGLISH.ppt

UltrasonographyonGynecologyandObstetrics LiuLiping Sangreal uterus THEDA WINCICODE PelvicCavityPosterior Occupiedbyrectum colon andileumAnterior bladder ureters ovaries fallopiantubes uterus andvagina NORMALANATOMY Pre inspection Moderatebladderfilling Uterus Hollow pear shapedorganDividedintofundus body andcervixUsuallyanteflexedandantevertedCoveredwithperitoneumexceptanteriorlybelowtheoswhereperitoneumisreflectedontobladderSupportedbylevatoranimusclesandpelvicfasciaRoundligamentkeepsuterusinposition Uterinesize Prepubertal 3cmlongby0 5to1 0cmwideMenarcheal 8cmlongby4cmwidePostmenopausal 3 5to5 5cmlongby1to2cmwideNormalsize 2 3 thick 4 5 width 7 8cm length Uterinelongitudinaldiameter Uterinewidediameter UterusbeforeandaftertheTrail length7 8cm beforeandaftertheTrail2 3cm width4 5cm UterinePosition Midlineanteversion mostcommon degreeofanteversionisbladderdistentiondependentRightorleft normalvariantinabsenceofpelvicmassesRetroverted entireorgandisplacedposteriorlyRetroflexed bodydisplacedwithrespecttocervix Ultrasonographyofnormaluterus Uterineserosalayer Linearhigh echo clear smooth Myometrium Homogeneousmiddle echo Endometria Themiddlelineofhighecho aroundtheweakecho Itiswellknownthattheendometriumchangesdynamicallyinresponsetocyclichormonalflux Uterineserosalayer Myometrium Endometria Normaluterustransabdominalultrasonography Transvaginalsagittalviewoftheuterus Theroundedfundusisshowntowardtheleftoftheimagewiththeendometrialstriperummingthroughthemiddleoftheuterinecavity Myometrium Endometria Uterineserosalayer FallopianTube 输卵管 Infundibulum funnel shapedlateraltubethatprojectsbeyondthebroadligamenttooverlietheovariesAmpulla sidestpartofthetubewherefertilizationoccursIsthmus hardestpart liesjustlateraltotheuterusLength 12cm suppliedbyovarionarteriesandveins Ovary 卵巢 AlmondshapedAttachedtobackofthebroadligamentbymesovarium sometimescalledsuspensoryligamentoftheovaryLiesinovarianfossaFossaisboundedbyexternaliliacvessels ureter andobturatornerveReceivesbloodfromovarianarteryBlooddrainedbyovarianveinintoinferiorvenacavaonright onleftbyovarianveinintolertrenalvein Sonographyofthenormalovary Anovoidhomogeneousechodensity follicularcystsareoftenpresent Thebestsonographicmarkerfortheovaryisidentificationofafollicularcyst whichhastheclassicappearanceofbeingthinwalledandanechoicwiththrough transmissionposteriorly Transabdominalsagittalimageshowstheleftovaryposteriortotheurinarybladder Transvaginalsagittalimageoftheovary ovarianfollicle Follicularwallflow CommonDiseasesofObstetricsandGynecology Gynecology Leiomyoma Carcinoma OvarianTumors Inflammatorymass etc Obstetrics Naturalpregnancy Abnormalpregnancy etc TheuterusLeiomyoma Hysteromyoma CharacteristicsofLeiomyomas MostcommonpelvictumorSmoothmusclecellcompositionFibrosisoccursafteratrophicofdegenerativechangesDegenerationoccurswhenfibroidsoutstriptheirbloodsupply calcificationMaybepedunculatedClinical enlargeduterus profuseandprolongedbleeding pain UterineLocationsofleiomyomas SubmucosalErodeintoendomertialcavity heavybleeding infertilityIntramuralMayenlargetocausepressureonadjacentorgans infertilitySubserosalMayenlargetocausepressureonadjacentorgans Subserousmyoma Broadligamentmyoma Cervicalmyoma intramurousmyoma Submucousmyoma Ultrasonicperformance Two dimensional IncreaseduterinebodyorFormdisorders Sphericalhypoechoicareaintheuterinebody Rearechoattenuation WithcalcificationorCysticchange etc Signsofoppression ColorDoppler Tumoraroundwiththebloodflowsignalintheshapeofringorsemi circularring Dopplerspectrum Mediumresistanceindex RI0 6 0 1 intramurousmyoma Subserousmyoma intramurousmyoma Subserousmyoma Cervicalmyoma Abundanttumorbloodflow M UT RI0 61 Submucousmyomawithcalcification TeratomaDermoidTummors 卵巢良性囊性畸胎瘤 皮样囊肿 Pathology derivesfromgermcell themostcommonovarianneoplasm constituting20 ofovariantumors upto20 arebilateral About80 occurinwomenofchildbearingage Sizerangesfromsmallto40cmUnliateral roundtoovalmassContainsfaty sebaceousmaterial hair cartilage bone teethClinical asymptomatictoabdominalpain enlargementandpressure pedunculated subjecttotorsionSonography Cystic complex solidmass echogeniccomponents acousticshadowing SpecialUltrasoundFindings 1 Acysticmass withanechogenicmuralnodule2 Apastesign particulateliptinite3 Afluffofhairsign4 Afat fluidlevelsign withfluidlevelinthecyst fatabove fluidbelow 5 Acomplexmass cysticteratomaofovary Acysticmass Pastesign Fluffofhairsign Pastesign Fat fluidlevelsign Acomplexmass A8yearsoldgirl cuttingoffathreekilogramsbenignteratoma TheroleofUltrasoundinObstetrics TRIMESTERS Firsttrimester 0to12weeksofgestationSecondtrimester 13to26weeksofgestationThirdtrimester 27to42weeksofgetsationPosttermpregnancy 42weeksofgestation IndicationsforFirst TrimesterSonography ConfirmpresenceofintrauterinepregnancyEvaluateforsuspectedectopicpregnancyDefinecauseofvaginalbleedingDeterminegestationalageConfirmsuspectedmultiplegestationsAidininvasiveproceduresEvaluatepelvicmassesDetectuterineabnormalities Naturalpregnancy Nonagepregnancy First Trimester Definition Pregnancybefore12weekend 5weekspregnant Gestationalsac 6 7weekspregnant Germ 7 8Weeks Primitivehearttubepulse 8 11weeks Yolksac 9weeks Embryonic placenta TheNormalFirstTrimester SonographicFeaturesofaNormalGestationalSac Shape roundofovalPosition fundalormiddleportionofuterus acenterpositionrelativetoendometriumContour smoothWall echogenic 3mmofmoreinthickness Internallandmarks yalksacpresentwhengestationalsacislargerthan10mm embryopresentwhengestationalsacislargerthan18mmGrowth 1mmperday range 0 7mmto1 5mmperday 4 5weekspregnantInthegestationalsacwecanseeaembryopoint theearliestembryo 7weekspregnantFetuswasabout4mm wecanseeapparentheartthrob andsmalllimbbud 8weekspregnantThree dimensionalultrasoundshowitsbeginningoftheshapeofahuman Umbilicalbord Embryonichead Embryonicabdomen Yolksac Embronichead Amnioticsac 9weekspregnantKnownasafetal Developmentofthevariouspartsofthefetus tendstoimprove 12weekspregnantThespineisidentifiable asthetwobead likehighecho Ears limbs bonescanbeshownandmeasurement UltrasoundoftheSecondandThirdTrimesters IndicationsforSecond andThird Trimester EstimategestationalageforpatientswithuncertaindatesEvaluateuterinesizeandclinicaldatediscrepanciesEvaluatefetalgrowthEstimatefetalweightDeterminefetalpresentationEvaluatefetallife provideadjuncttoamniocentesis percutaneousumbilicalbloodsamplingprocedure orcerclageplacementEvaluateuterineabnormalityEvaluateabnoumalmaternalserumalpha fetoproteinvaluesEvaluateabnormalamnioticfluidEvaluateplacentaEtc TheSecond andThird Trimester Metaphaseandterminalprengancy Mid pregnancy 13 27weekspregnancy Late pregnancy Morethan28weeksofpregnancy ScanningTechniques SurveyuterusObservecardiacactivityDeterminepositionandnumberofthefetusandplacentaAssessamnioticfluidLookforuterineofplacentalmassesandfetalanomalies Checkcontents 1 Fetalhead BPDbiparietaldiameter 2 Fetalabdomen ACabdomencircumference 3 Fetallimb FLfemurlength 4 Others Placenta Fetalheartrate Amnioticfluid etc 1 Fetalhead MeasuringtheBiparietalDiameter BPD Obitainbiparietaldiameterofthefetalheadatthetransverselevelofthemidbrain falx cavumseptipellucidi andthalamicnucleiMakesuretheheadissymmetricandovalMeasurefromoutertoinnermarginsoftheskullInthethirdtrimester theBPDisnotasaccurateinpredictingfetalage Fetalhead after12weekendpregnant Fetalsideprofile wecanobserveitsforehead nose lip andchin etc 2 Fetalabdomen Thehepatobiliarysystem liver portvenoussysterm hepaticveinsandarteries gallbladder andbileductsThegastrointestinalsystem theesophagus stomach smallandlargeintestines colon Theurinarysystem kidneys adrenalglands ureters bladder Thefetalabdomencircumference AC isthemostwidelymeasured MeasuringtheAbdominalCircumference AC TheACshouldbetakenfromaroundtransverseimagewiththeumbilicalportionoftheleftportalveinmidlinewithintheliverTheoutermarginoftheabdominalwallshouldbemeasuredTheabdominalwallmeasurementistheleastaccurate Thefetalliver gallbladder stomach portvenous spine gallbladder stomach 3 Fetallimbs Theupperlimbs theulnatheradiusthehumerusThelowerlimbs thefemur thethighbonethefibulathetibiaThefemuristhemostwidelymeasuredlongbone FLfemurlength Femurmeasurement HyperechoniclinearstructurerepresentstheossifiedportionofthefemoualdiaphysisandcorrespondstofemorallengthmeasurementfromthegreatertrochantertothefemoralcondylesThemormalfemurhasastraightlaeralborderandacurvedmed