妇产科疾病的超声诊断.ppt

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1、Ultrasonography on Gynecology and Obstetrics,Sangreal-uterus,THE DA,WINCI CODE,Pelvic CavityPosterior:Occupied by rectum,colon,and ileumAnterior:bladder,ureters,ovaries,fallopian tubes,uterus,and vagina,NORMAL ANATOMY,Pre-inspection:,Moderate bladder filling,Uterus,Hollow,pear-shaped organDivided in

2、to fundus,body,and cervixUsually anteflexed and antevertedCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in position,Uterine size,Prepubertal:3 cm long by 0.5 to 1.0 cm wid

3、eMenarcheal:8 cm long by 4 cm widePostmenopausal:3.5 to 5.5 cm long by 1 to 2 cm wideNormal 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 antev

4、ersion:most common;degree of anteversion is bladder distention dependentRight or left:normal variant in absence of pelvic massesRetroverted:entire organ displaced posteriorlyRetroflexed:body displaced with respect to cervix,Ultrasonography of normal uterus,Uterine serosa layer:Linear high-echo;clear

5、,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 uterustransabdominal ultrasonography,Transvaginal s

6、agittal 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 liga

7、ment to overlie the ovariesAmpulla:sidest part of the tube where fertilization occursIsthmus:hardest part;lies just lateral to the uterusLength:12 cm;supplied by ovarion arteries and veins,Ovary（卵 巢）,Almond shapedAttached to back of the broad ligament by mesovarium;sometimes called suspensory ligame

8、nt of the ovaryLies in ovarian fossaFossa is bounded by external iliac vessels,ureter,and obturator nerveReceives blood from ovarian arteryBlood 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 e

9、chodensity;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

10、 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,Cha

11、racteristics of Leiomyomas,Most common pelvic tumorSmooth muscle cell compositionFibrosis occurs after atrophic of degenerative changesDegeneration occurs when fibroids outstrip their blood supply;calcificationMay be pedunculatedClinical:enlarged uterus,profuse and prolonged bleeding,pain,Uterine Lo

12、cations of leiomyomas,Submucosal Erode into endomertial cavity heavy bleeding;infertilityIntramuralMay enlarge to cause pressure on adjacent organs;infertilitySubserosalMay enlarge to cause pressure on adjacent organs,Subserous myoma,Broad ligamentmyoma,Cervical myoma,intramurous myoma,Submucous myo

13、ma,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-circul

14、ar 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

15、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 cmUnliateral,round to oval massContains faty,sebaceous material,hair,cartilage,bone,teethClinical:asymptomatic to abdominal pain,enlargement and

16、pressure;pedunculated,subject to torsionSonography:Cystic/complex/solid mass,echogenic components;acoustic shadowing,Special Ultrasound Findings:,1.A cystic mass:with an echogenic mural nodule2.A paste sign：particulate liptinite3.A fluff of hair sign4.A fat-fluid level sign：with fluid level in the c

17、yst,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 week

18、s of gestationSecond trimester=13 to 26 weeks of gestationThird trimester=27 to 42 weeks of getsationPostterm pregnancy=42 weeks of gestation,Indications for First-Trimester Sonography,Confirm presence of intrauterine pregnancyEvaluate for suspected ectopic pregnancyDefine cause of vaginal bleedingD

19、etermine gestational ageConfirm suspected multiple gestationsAid in invasive proceduresEvaluate pelvic massesDetect 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 Pri

20、mitive 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 ovalPosition:fundal or middle portion of uterus;a center position relative to endometriumContour:smoothWall:echogenic;3 mm of more in thi

21、ckness,Internal landmarks:yalk sac present when gestational sac is larger than 10 mm;embryo present when gestational sac is larger than 18 mmGrowth: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 F

22、etus 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 v

23、arious parts of the fetus,tends to improve.,12 weeks pregnantThe 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 unc

24、ertain datesEvaluate uterine size and clinical date discrepanciesEvaluate fetal growthEstimate fetal weightDetermine fetal presentationEvaluate fetal life,provide adjunct to amniocentesis,percutaneous umbilical blood sampling procedure,or cerclage placementEvaluate uterine abnormalityEvaluate abnoum

25、al maternal serum alpha-fetoprotein valuesEvaluate abnormal amniotic fluidEvaluate 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 acti

26、vityDetermine position and number of the fetus and placentaAssess amniotic fluidLook 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,Amniot

27、ic 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 nucleiMake sure the head is symmetric and ovalMeasure from outer to inner margins of the skullIn the third tr

28、imester,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 ductsThe gastrointe

29、stinal 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 umbil

30、ical portion of the left portal vein midline within the liverThe outer margin of the abdominal wall should be measuredThe 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 h

31、umerusThe 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

32、 trochanter to the femoral condylesThe mormal femur has a straight laeral border and a curved medial borderFemur length may be used with the same accuracy as BPD to predict gestational ageFemur length may indicate skeletal dysplasias or intrauterine growth restriction,Long section of the upper limbs

33、,The radius,The ulna,The humerus,Femur/thigh bone,Fibula/perone,Tibia/shin bone,Long section of the lower limbs,4、The placenta（胎盘）,The major fole of the placenta is to permit the exchange of oxygenated maternal blood(rich in oxgen and nutrients)with deoxygenated fetal blood.The thickness of the plac

34、enta varies with gestational age,with a minimum diameter of 15 mm in fetuses greater than 23 weeks.The size of the placenta rarely exceeds 50 mm in the normal fetus.,Anterior placenta at 21 weeks of gastation,The placenta,Umbilical bord,Amniotic fluid,The fetal,posterior placenta at 29 weeks of gestation,calcification,Anterior placenta at 39 weeks of gastation,Calm little face,Eating toe,Eating fingers,Crying,Poutting,Fetal with umbilical cord around the neck,Fetal with cleft lip,smailing,Bao bao,Bei bei 100 days old!,Bao bao,Bei bei 1 years birthday!,THANKS ALL!,