妇产科疾病的超声诊断

UltrasonographyonGynecologyandObstetrics精选课件Sangreal--------uterusTHEDAWINCICODE精选课件PelvicCavityPosterior:Occupiedbyrectum,colon,andileumAnterior:bladder,ureters,ovaries,fallopiantubes,uterus,andvaginaNORMALANATOMY精选课件Pre-inspection:Moderatebladderfilling

精选课件UterusHollow,pear-shapedorganDividedintofundus,body,andcervixUsuallyanteflexedandantevertedCoveredwithperitoneumexceptanteriorlybelowtheoswhereperitoneumisreflectedontobladderSupportedbylevatoranimusclesandpelvicfasciaRoundligamentkeepsuterusinposition精选课件UterinesizePrepubertal:3cmlongby0.5to1.0cmwideMenarcheal:8cmlongby4cmwidePostmenopausal:3.5to5.5cmlongby1to2cmwideNormalsize:2~3(thick)×4~5(width)×7~8cm(length)精选课件Uterinelongitudinaldiameter

Uterinewidediameter

UterusbeforeandaftertheTrail

精选课件length7~8cmbeforeandaftertheTrail

2~3cmwidth4~5cm精选课件UterinePositionMidlineanteversion:mostcommon;degreeofanteversionisbladderdistentiondependentRightorleft:normalvariantinabsenceofpelvicmassesRetroverted:entireorgandisplacedposteriorlyRetroflexed:bodydisplacedwithrespecttocervix精选课件UltrasonographyofnormaluterusUterineserosalayer:Linearhigh-echo;clear,smooth;

Myometrium:Homogeneousmiddle-echo;Endometria:Themiddlelineofhighecho,aroundtheweakecho.Itiswellknownthattheendometriumchangesdynamicallyinresponsetocyclichormonalflux.精选课件Uterineserosalayer

Myometrium

Endometria

Normaluterustransabdominalultrasonography精选课件Transvaginalsagittalviewoftheuterus.Theroundedfundusisshowntowardtheleftoftheimagewiththeendometrialstriperummingthroughthemiddleoftheuterinecavity.MyometriumEndometriaUterineserosalayer精选课件FallopianTube（输卵管）Infundibulum:funnel-shapedlateraltubethatprojectsbeyondthebroadligamenttooverlietheovariesAmpulla:sidestpartofthetubewherefertilizationoccursIsthmus:hardestpart;liesjustlateraltotheuterusLength:12cm;suppliedbyovarionarteriesandveins精选课件Ovary（卵巢）AlmondshapedAttachedtobackofthebroadligamentbymesovarium;sometimescalledsuspensoryligamentoftheovaryLiesinovarianfossaFossaisboundedbyexternaliliacvessels,ureter,andobturatornerveReceivesbloodfromovarianarteryBlooddrainedbyovarianveinintoinferiorvenacavaonright;onleftbyovarianveinintolertrenalvein精选课件SonographyofthenormalovaryAnovoidhomogeneousechodensity;follicularcystsareoftenpresent.Thebestsonographicmarkerfortheovaryisidentificationofafollicularcyst,whichhastheclassicappearanceofbeingthinwalledandanechoicwiththrough-transmissionposteriorly.精选课件Transabdominalsagittalimageshowstheleftovaryposteriortotheurinarybladder精选课件Transvaginalsagittalimageoftheovaryovarianfollicle精选课件Follicularwallflow精选课件CommonDiseasesofObstetricsandGynecologyGynecology：Leiomyoma；Carcinoma;；OvarianTumors;Inflammatorymass;etc.Obstetrics：

Naturalpregnancy；Abnormalpregnancy;etc.精选课件TheuterusLeiomyoma/Hysteromyoma精选课件CharacteristicsofLeiomyomasMostcommonpelvictumorSmoothmusclecellcompositionFibrosisoccursafteratrophicofdegenerativechangesDegenerationoccurswhenfibroidsoutstriptheirbloodsupply;calcificationMaybepedunculatedClinical:enlargeduterus,profuseandprolongedbleeding,pain精选课件UterineLocationsofleiomyomasSubmucosalErodeintoendomertialcavity–heavybleeding;infertilityIntramuralMayenlargetocausepressureonadjacentorgans;infertilitySubserosalMayenlargetocausepressureonadjacentorgans精选课件SubserousmyomaBroadligamentmyomaCervicalmyomaintramurousmyomaSubmucousmyoma精选课件UltrasonicperformanceTwo-dimensional：①IncreaseduterinebodyorFormdisorders；②Sphericalhypoechoicareaintheuterinebody，Rearechoattenuation；③WithcalcificationorCysticchange,etc；④Signsofoppression；ColorDoppler：Tumoraroundwiththebloodflowsignalintheshapeofringorsemi-circularring；Dopplerspectrum：Mediumresistanceindex，RI0.6±0.1。精选课件intramurousmyoma精选课件Subserousmyomaintramurousmyoma精选课件Subserousmyoma精选课件Cervicalmyoma精选课件AbundanttumorbloodflowMUT精选课件RI0.61精选课件Submucousmyomawithcalcification精选课件Teratoma

DermoidTummors

（卵巢良性囊性畸胎瘤/皮样囊肿)Pathology：derivesfromgermcell，themostcommonovarianneoplasm,constituting20%ofovariantumors.upto20%arebilateral.About80%occurinwomenofchildbearingage.精选课件Sizerangesfromsmallto40cmUnliateral,roundtoovalmassContainsfaty,sebaceousmaterial,hair,cartilage,bone,teethClinical:asymptomatictoabdominalpain,enlargementandpressure;pedunculated,subjecttotorsionSonography:Cystic/complex/solidmass,echogeniccomponents;acousticshadowing精选课件SpecialUltrasoundFindings:1.Acysticmass:

withanechogenicmuralnodule2.Apastesign：particulateliptinite3.Afluffofhairsign4.Afat-fluidlevelsign：withfluidlevelinthecyst,fatabove,fluidbelow.5.Acomplexmass精选课件cysticteratomaofovaryAcysticmassPastesignFluffofhairsign精选课件PastesignFat-fluidlevelsignAcomplexmass精选课件A8yearsoldgirl,cuttingoffathreekilogramsbenignteratoma精选课件TheroleofUltrasoundinObstetrics精选课件TRIMESTERSFirsttrimester=0to12weeksofgestationSecondtrimester=13to26weeksofgestationThirdtrimester=27to42weeksofgetsationPosttermpregnancy=>42weeksofgestation精选课件IndicationsforFirst-TrimesterSonographyConfirmpresenceofintrauterinepregnancyEvaluateforsuspectedectopicpregnancyDefinecauseofvaginalbleedingDeterminegestationalageConfirmsuspectedmultiplegestationsAidininvasiveproceduresEvaluatepelvicmassesDetectuterineabnormalities精选课件Naturalpregnancy精选课件Nonagepregnancy

(First-Trimester)Definition：Pregnancybefore12weekend.精选课件5weekspregnant—

Gestationalsac；6-7weekspregnant—Germ;7-8Weeks—Primitivehearttubepulse；8-11weeks—Yolksac;9weeks—Embryonic,placenta.TheNormalFirstTrimester精选课件SonographicFeaturesofaNormalGestationalSacShape:roundofovalPosition:fundalormiddleportionofuterus;acenterpositionrelativetoendometriumContour:smoothWall:echogenic;3mmofmoreinthickness精选课件Internallandmarks:yalksacpresentwhengestationalsacislargerthan10mm;embryopresentwhengestationalsacislargerthan18mmGrowth:1mmperday(range:0.7mmto1.5mmperday)精选课件4-5weekspregnantInthegestationalsacwecanseeaembryopoint,theearliestembryo.精选课件7weekspregnant

Fetuswasabout4mm，wecanseeapparentheartthrob,andsmalllimbbud.精选课件8weekspregnant

Three-dimensionalultrasoundshowitsbeginningoftheshapeofahuman.精选课件UmbilicalbordEmbryonicheadEmbryonicabdomen精选课件YolksacEmbronicheadAmnioticsac精选课件9weekspregnant

Knownasafetal，Developmentofthevariouspartsofthefetus,tendstoimprove.精选课件12weekspregnantThespineisidentifiable,asthetwobead-likehighecho.Ears,limbs,bonescanbeshownandmeasurement.精选课件UltrasoundoftheSecondandThirdTrimesters精选课件IndicationsforSecond-and

Third-TrimesterEstimategestationalageforpatientswithuncertaindatesEvaluateuterinesizeandclinicaldatediscrepanciesEvaluatefetalgrowthEstimatefetalweightDeterminefetalpresentationEvaluatefetallife精选课件provideadjuncttoamniocentesis,percutaneousumbilicalbloodsamplingprocedure,orcerclageplacementEvaluateuterineabnormalityEvaluateabnoumalmaternalserumalpha-fetoproteinvaluesEvaluateabnormalamnioticfluidEvaluateplacentaEtc.精选课件TheSecond-and

Third-Trimester

(Metaphaseandterminalprengancy)Mid-pregnancy:13-27weekspregnancy.Late-pregnancy:Morethan28weeksofpregnancy.精选课件ScanningTechniquesSurveyuterusObservecardiacactivityDeterminepositionandnumberofthefetusandplacentaAssessamnioticfluidLookforuterineofplacentalmassesandfetalanomalies精选课件Checkcontents1、Fetalhead：BPD

biparietaldiameter;2、Fetalabdomen:ACabdomencircumference;3、Fetallimb：FLfemurlength;4、Others：Placenta,Fetalheartrate,Amnioticfluid,etc.精选课件1、FetalheadMeasuringtheBiparietalDiameter(BPD)Obitainbiparietaldiameterofthefetalheadatthetransverselevelofthemidbrain:falx,cavumseptipellucidi,andthalamicnucleiMakesuretheheadissymmetricandovalMeasurefromoutertoinnermarginsoftheskullInthethirdtrimester,theBPDisnotasaccurateinpredictingfetalage精选课件Fetalhead,after12weekendpregnant精选课件Fetalsideprofile,wecanobserveitsforehead,nose,lip,andchin,etc.精选课件2、FetalabdomenThehepatobiliarysystem:liver,portvenoussysterm,hepaticveinsandarteries,gallbladder,andbileductsThegastrointestinalsystem:theesophagus,stomach,smallandlargeintestines(colon)精选课件Theurinarysystem:kidneys,adrenalglands,ureters,bladder.Thefetalabdomencircumference（AC)

isthemostwidelymeasured精选课件MeasuringtheAbdominalCircumference(AC)TheACshouldbetakenfromaroundtransverseimagewiththeumbilicalportionoftheleftportalveinmidlinewithintheliverTheoutermarginoftheabdominalwallshouldbemeasuredTheabdominalwallmeasurementistheleastaccurate精选课件Thefetallivergallbladderstomachportvenousspinegallbladderstomach精选课件3、FetallimbsTheupperlimbs:theulnatheradiusthehumerusThelowerlimbs:thefemur/thethighbonethefibulathetibiaThefemuristhemostwidelymeasuredlongbone（FLfemurlength）精选课件FemurmeasurementHyperechoniclinearstructurerepresentstheossifiedportionofthefemoualdiaphysisandcorrespondstofemorallengthmeasurementfromthegreatertrochantertothefemoralcondylesThemormalfemurhasastraightlaeralborderandacu