妇科疾病的超声诊断英文教学课件

1、Ultrasonography on GynecologySangreal-uterusTHE DAWINCI CODE Pelvic CavityPosterior : Occupied by rectum, colon, and ileumAnterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vaginaNORMAL ANATOMYPre-inspection :Transabdminal examination: Moderate bladder filling Transvaginal examination

2、: No necessaryUterusHollow, pear-shaped organDivided into fundus, body, and cervixCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in positionUterine sizePrepubertal : 3 cm l

3、ong by 0.5 to 1.0 cm wideMenarcheal: 8 cm long by 4 cm widePostmenopausal: 3.5 to 5.5 cm long 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 PositionMidline antevers

4、ion: 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 cervixUsually anteflexed and antevertedUltrasonography of normal uterusUterine se

5、rosa 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 uterustr

6、ansabdominal ultrasonographyTransvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe running through the middle of the uterine cavity.MyometriumEndometriaUterine serosa layerFallopian Tube（输卵管）Infundibulum: funnel-shaped lateral t

7、ube that projects beyond the broad ligament 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 veinsOvary（卵 巢） Almond shapedAttached to back of the broad ligament by me

8、sovarium; sometimes called suspensory ligament 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 left renal veinSonogra

9、phy of the normal ovaryAn 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 sagitt

10、al image shows the left ovary posterior to the urinary bladderTransvaginal sagittal image of the ovaryovarian follicleFollicular wall flowCommon Diseases of Obstetrics and GynecologyGynecology ：Leiomyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc.Obstetrics： Natural pregnancy ； Abnormal pre

11、gnancy; etc.The uterus Leiomyoma /HysteromyomaCharacteristics of LeiomyomasMost common pelvic tumorSmooth muscle cell compositionFibrosis occurs after atrophic of degenerative changesDegeneration occurs when fibroids outstrip their blood supply; calcificationMay be pedunculatedClinical: enlarged ute

12、rus, profuse and prolonged bleeding, painUterine Locations of leiomyomasSubmucosal Erode into endomertial cavity heavy bleeding; infertilityIntramuralMay enlarge to cause pressure on adjacent organs; infertilitySubserosalMay enlarge to cause pressure on adjacent organs Subserous myomaBroad ligamentm

13、yomaCervical myomaintramurous myomaSubmucous myomaUltrasound findingsTwo-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the uterine body ，Rear echo attenuation； With calcification or Cystic changes, etc；Signs of oppression；Color Doppler：Tumor around with the blood

14、 flow signal in the shape of ring or semi-circular ring ；Spectrum Doppler：Medium resistance index，RI 0.60.1。intramurous myomaSubserous myomaintramurous myomaSubserous myomaCervical myomaRI 0.61Submucous myoma with calcificationTeratoma Dermoid Tummors（卵巢良性囊性畸胎瘤/皮样囊肿)Pathology ：derives from germ cell

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

16、pain, enlargement and pressure; pedunculated, subject to torsionSonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowingSpecial 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 si