妇产科疾病的超声诊断课件.ppt

1、妇产科疾病的超声诊断1妇产科疾病的超声诊断2 Pelvic CavitylPosterior:Occupied by rectum,colon,and ileumlAnterior:bladder,ureters,ovaries,fallopian tubes,uterus,and vagina妇产科疾病的超声诊断3Moderate bladder filling 妇产科疾病的超声诊断4lHollow,pear-shaped organlDivided into fundus,body,and cervixlUsually anteflexed and antevertedlCovered w

2、ith peritoneum except anteriorly below the os where peritoneum is reflected onto bladderlSupported by levator ani muscles and pelvic fascialRound ligament keeps uterus in position妇产科疾病的超声诊断5lPrepubertal:3 cm long by 0.5 to 1.0 cm widelMenarcheal:8 cm long by 4 cm widelPostmenopausal:3.5 to 5.5 cm lo

3、ng by 1 to 2 cm wideNormal size:23(thick)45(width)78 cm(length)妇产科疾病的超声诊断6Uterine longitudinal diameter Uterine wide diameter Uterus before and after the Trail 妇产科疾病的超声诊断7length 78cmbefore and after the Trail 23cmwidth 45cm妇产科疾病的超声诊断8lMidline anteversion:most common;degree of anteversion is bladder

4、distention dependentlRight or left:normal variant in absence of pelvic masseslRetroverted:entire organ displaced posteriorlylRetroflexed:body displaced with respect to cervix妇产科疾病的超声诊断9lUterine serosa layer:Linear high-echo;clear,smooth;l Myometrium:Homogeneous middle-echo;lEndometria:The middle lin

5、e of high echo,around the weak echo.It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.妇产科疾病的超声诊断10Uterine serosa layer Myometrium Endometria 妇产科疾病的超声诊断11MyometriumEndometriaUterine serosa layer妇产科疾病的超声诊断12lInfundibulum:funnel-shaped lateral tube that proje

6、cts beyond the broad ligament to overlie the ovarieslAmpulla:sidest part of the tube where fertilization occurslIsthmus:hardest part;lies just lateral to the uteruslLength:12 cm;supplied by ovarion arteries and veins妇产科疾病的超声诊断13l Almond shapedlAttached to back of the broad ligament by mesovarium;som

7、etimes called suspensory ligament of the ovarylLies in ovarian fossalFossa is 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 lert renal vein妇产科疾病的超声诊断14lAn ovo

8、id homogeneous echodensity;follicular cysts are often present.lThe 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.妇产科疾病的超声诊断15妇产科疾病的超声诊断16ovarian follicle妇产科疾病的超声诊断1

9、7妇产科疾病的超声诊断18Gynecology：Leiomyoma；Carcinoma;；Ovarian Tumors;Inflammatory mass;etc.Obstetrics：NaturalNatural pregnancy；Abnormal pregnancy;etc.妇产科疾病的超声诊断19妇产科疾病的超声诊断20lMost common pelvic tumorlSmooth muscle cell compositionlFibrosis occurs after atrophic of degenerative changeslDegeneration occurs whe

10、n fibroids outstrip their blood supply;calcificationlMay be pedunculatedlClinical:enlarged uterus,profuse and prolonged bleeding,pain妇产科疾病的超声诊断21Submucosal Erode into endomertial cavity heavy bleeding;infertilityIntramuralMay enlarge to cause pressure on adjacent organs;infertilitySubserosalMay enla

11、rge to cause pressure on adjacent organs 妇产科疾病的超声诊断22Subserous myomaBroad ligamentmyomaCervical myomaintramurous myomaSubmucous myoma妇产科疾病的超声诊断23lTwo-dimensional：Increased uterine body or Form disorders；Spherical hypoechoic area in the uterine body，Rear echo attenuation；With calcification or Cystic

12、change,etc；Signs of oppression；lColor Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring；lDoppler spectrum：Medium resistance index，RI 0.60.1。妇产科疾病的超声诊断24intramurous myoma妇产科疾病的超声诊断25Subserous myomaintramurous myoma妇产科疾病的超声诊断26Subserous myoma妇产科疾病的超声诊断27Cervica

13、l myoma妇产科疾病的超声诊断28M妇产科疾病的超声诊断29妇产科疾病的超声诊断30Submucous myoma with calcification妇产科疾病的超声诊断31lPathology：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.妇产科疾病的超声诊断32lSize ranges from small to 40

14、cmlUnliateral,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 shadowing妇产科疾病的超声诊断331.A cystic mass:with an

15、 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 mass妇产科疾病的超声诊断34A cystic massPaste signFluff of hair sign妇产科疾病的超声诊断35Paste signFat-fluid level signA complex mass妇产科疾病的超声诊断36妇产科疾病的

16、超声诊断37妇产科疾病的超声诊断38lFirst trimester =0 to 12 weeks of gestationlSecond trimester =13 to 26 weeks of gestationlThird trimester =27 to 42 weeks of getsationlPostterm pregnancy=42 weeks of gestation妇产科疾病的超声诊断39lConfirm presence of intrauterine pregnancylEvaluate for suspected ectopic pregnancylDefine ca

17、use of vaginal bleedinglDetermine gestational agelConfirm suspected multiple gestationslAid in invasive procedureslEvaluate pelvic masseslDetect uterine abnormalities妇产科疾病的超声诊断40妇产科疾病的超声诊断41Definition：Pregnancy before 12 weekend.妇产科疾病的超声诊断425 weeks pregnant Gestational sac；6-7 weeks pregnant Germ;7-

18、8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac;9 weeks Embryonic,placenta.妇产科疾病的超声诊断43lShape:round of ovallPosition:fundal or middle portion of uterus;a center position relative to endometriumlContour:smoothlWall:echogenic;3 mm of more in thickness妇产科疾病的超声诊断44lInternal landmarks:yalk sac pre

19、sent when gestational sac is larger than 10 mm;embryo present when gestational sac is larger than 18 mmlGrowth:1 mm per day(range:0.7 mm to 1.5 mm per day)妇产科疾病的超声诊断45妇产科疾病的超声诊断46妇产科疾病的超声诊断47妇产科疾病的超声诊断48Umbilical bordEmbryonic headEmbryonic abdomen妇产科疾病的超声诊断49Yolk sacEmbronic headAmniotic sac妇产科疾病的超

20、声诊断50妇产科疾病的超声诊断51妇产科疾病的超声诊断52妇产科疾病的超声诊断53l Estimate gestational age for patients with uncertain dateslEvaluate uterine size and clinical date discrepancieslEvaluate fetal growthlEstimate fetal weightlDetermine fetal presentationlEvaluate fetal life妇产科疾病的超声诊断54l provide adjunct to amniocentesis,percu

21、taneous umbilical blood sampling procedure,or cerclage placementlEvaluate uterine abnormalitylEvaluate abnoumal maternal serum alpha-fetoprotein valueslEvaluate abnormal amniotic fluidlEvaluate placenta Etc.妇产科疾病的超声诊断55妇产科疾病的超声诊断56lSurvey uterus lObserve cardiac activitylDetermine position and numbe

22、r of the fetus and placentalAssess amniotic fluidlLook for uterine of placental masses and fetal anomalies妇产科疾病的超声诊断57l1、Fetal head：BPD biparietal diameter;l2、Fetal abdomen:AC abdomen circumference;l3、Fetal limb：FL femur length;l4、Others：Placenta,Fetal heart rate,Amniotic fluid,etc.妇产科疾病的超声诊断58Measu

23、ring the Biparietal Diameter(BPD)lObitain biparietal diameter of the fetal head at the transverse level of the midbrain:falx,cavum septi pellucidi,and thalamic nucleilMake sure the head is symmetric and ovallMeasure from outer to inner margins of the skulllIn the third trimester,the BPD is not as ac

24、curate in predicting fetal age 妇产科疾病的超声诊断59妇产科疾病的超声诊断60妇产科疾病的超声诊断61lThe hepatobiliary system:liver,port venous systerm,hepatic veins and arteries,gallbladder,and bile ductslThe gastrointestinal system:the esophagus,stomach,small and large intestines(colon)妇产科疾病的超声诊断62lThe urinary system:kidneys,adre

25、nal glands,ureters,bladder.The fetal abdomen circumference（AC)is the most widely measured 妇产科疾病的超声诊断63lThe AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverlThe outer margin of the abdominal wall should be measuredlThe abdomi

26、nal wall measurement is the least accurate妇产科疾病的超声诊断64gallbladderstomachport venousspinegallbladderstomach妇产科疾病的超声诊断65lThe upper limbs:the ulna the radius the humeruslThe lower limbs:the femur/the thigh bone the fibula the tibia lThe femur is the most widely measured long bone（FL femur length ）妇产科疾病

27、的超声诊断66lHyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condyleslThe mormal femur has a straight laeral border and a curved medial borderlFemur length may be used with the

28、same accuracy as BPD to predict gestational agelFemur length may indicate skeletal dysplasias or intrauterine growth restriction妇产科疾病的超声诊断67The radiusThe ulnaThe humerus 妇产科疾病的超声诊断68Femur/thigh boneFibula/perone Tibia/shin bone 妇产科疾病的超声诊断69lThe major fole of the placenta is to permit the exchange of

29、 oxygenated maternal blood(rich in oxgen and nutrients)with deoxygenated fetal blood.lThe thickness of the placenta 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.妇产科疾病的超声诊断70The placentaUmbilical bordAmniotic fluidThe fetal妇产科疾病的超声诊断71calcification 妇产科疾病的超声诊断72妇产科疾病的超声诊断73妇产科疾病的超声诊断74妇产科疾病的超声诊断75妇产科疾病的超声诊断76妇产科疾病的超声诊断77妇产科疾病的超声诊断78妇产科疾病的超声诊断79妇产科疾病的超声诊断80