妇科疾病的超声诊断.ppt

1、妇科疾病的超声诊断 Pelvic CavitylPosterior:Occupied by rectum,colon,and ileumlAnterior:bladder,ureters,ovaries,fallopian tubes,uterus,and vaginaNORMAL Transabdminal examination:Moderate bladder filling Transvaginal examination:No necessaryUtelHollow,pear-shaped organlDivided into fundus,body,and cervixlCover

2、ed with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderlSupported by levator ani muscles and pelvic fascialRound ligament keeps uterus in positionUterilPrepubertal:3 cm long by 0.5 to 1.0 cm widelMenarcheal:8 cm long by 4 cm widelPostmenopausal:3.5 to 5.5 cm long

3、 by 1 to 2 cm wideNormal size:23cm(thick)45cm(wide)78 cm(long)longitudinal diameter wide diameter Anteroposterior diameter length 78cmAnteroposterior diameter 23cmwidth 45cmUterine lMidline anteversion:most common;degree of anteversion is bladder distention dependentlRight or left:normal variant in

4、absence of pelvic masseslRetroverted:entire organ displaced posteriorlylRetroflexed:body displaced with respect to cervixlUsually anteflexed and antevertedlUterine serosa layer:Linear high-echo;clear,smooth;l Myometrium:Homogeneous middle-echo;lEndometria:The middle line of high echo,around the weak

5、 echo.It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.Uterine serosa layer Myometrium Endometria MyometriumEndometriaUterine serosa layerlInfundibulum:funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovarieslAmpulla:sides

6、t part of the tube where fertilization occurslIsthmus:hardest part;lies just lateral to the uteruslLength:12 cm;supplied by ovarion arteries and veinsl Almond shapedlAttached to back of the broad ligament by mesovarium;sometimes called suspensory ligament of the ovarylLies in ovarian fossalFossa is

7、bounded by external iliac vessels,ureter,and obturator nervelReceives blood from ovarian arterylBlood drained by ovarian vein into inferior vena cava on right;on left by ovarian vein into left renal veinlAn ovoid homogeneous echodensity;follicular cysts are often present.lThe best sonographic marker

8、 for the ovary is identification of a follicular cyst,which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.ovarian follicleGynecology：Leiomyoma；Carcinoma;；Ovarian Tumors;Inflammatory mass;etc.Obstetrics：NaturalNatural pregnancy；Abnormal pregnancy;e

9、tc.lMost common pelvic tumorlSmooth muscle cell compositionlFibrosis occurs after atrophic of degenerative changeslDegeneration occurs when fibroids outstrip their blood supply;calcificationlMay be pedunculatedlClinical:enlarged uterus,profuse and prolonged bleeding,painSubmucosal Erode into endomer

10、tial cavity heavy bleeding;infertilityIntramuralMay enlarge to cause pressure on adjacent organs;infertilitySubserosalMay enlarge to cause pressure on adjacent organs Subserous myomaBroad ligamentmyomaCervical myomaintramurous myomaSubmucous myomalTwo-dimensional：Increased uterine body or Form disor

11、ders；Spherical hypoechoic area in the uterine body，Rear echo attenuation；With calcification or Cystic changes,etc；Signs of oppression；lColor Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring；lSpectrum Doppler：Medium resistance index，RI 0.60.1。intramurous myom

12、aSubserous myomaintramurous myomaSubserous myomaCervical myomaSubmucous myoma with calcificationlPathology：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.lSize ranges from small to 40 cmlUnl

13、iateral,round to oval masslContains faty,sebaceous material,hair,cartilage,bone,teethlClinical:asymptomatic to abdominal pain,enlargement and pressure;pedunculated,subject to torsionlSonography:Cystic/complex/solid mass,echogenic components;acoustic shadowing1.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 cyst,fat above,fluid below.5.A complex massA cystic massPaste signFluff of hair signPaste signFat-fluid level signA complex massM