影像诊断学教学课件：Gynaecology and Obstetrics

GynaecologyandObstetricsUltrasoundGynaecololgyandObstetricsPelviclongitudinalviews.Probeposition(L)andcorrespondingultrasoundimage(R).BUEM----CVPelvictransverseviews:Probeposition(L)andcorrespondingultrasoundimage(R)BUTransvaginalviewofnormaluterusandovaryCommondiseasesofGynaecologyFibroidintramualfibroidFibroidSubserousfibroidFibroidSubmucousfibroidFibroidwithacalcifiedrim/colorDoppler/cervicalAdenomyosisofuterusIntrauterinedevice,IUDIntrauterinedevice,IUDLeftovariancystHemorrhagiccystHemorrhagicovariancyst.Transvaginalandtransabdominalviewsdemonstratesacomplexrightovariancyst(arrows)adjacenttoanormaluterus(U)andleftovary(arrowhead).OvarianTeratomaOvarianteratomacontainingfat.Transvaginalimagesofamass(calipers)intherightovaryfilledwithcomplex,highlyechogenicmaterialrepresentingfat.Ovarianteratomawithahighlyechogenicsolidnoduleoftissueinthewall.Imageofanovarydemonstratesacomplex,cysticmass(calipers)withanechogenicsolidnoduleoftissue(arrows)protrudingfromthewallintothemass.RightOvarianTeratomaandcystOvarianserouscystadenomaOvarianserouscystadenoma.Transvaginalsagittalimageofaleftovary(SAGLT)thatcontainsamultilocularcysticlesion(largearrows)withthickseptations(arrowheads).ColorDopplershowsbloodflow(smallarrows)withinthewallandintheseptations.Dopplergateplacedonbloodflowinaseptationdemonstratesaresistiveindexof0.43(RIarrowhead).OvarianpapillaryserouscystadenomaOvarianpapillaryserouscystadenoma.Transvaginalimageofanovarycontainingacomplexmass(calipers)withanechoicareas(arrows)andmorecomplex,solid-appearingareas(arrowheads).ColorDopplerdemonstratesbloodflow(arrow)withinasolidportionofthetumor,witharesistiveindexof0.61(RIarrowhead).Darklettersagainstalightbackground.MalignantOvarianTumorOvarianpapillarycystadenocarcinomawithsolidnoduleinwall.Imagesofanovarianmass(calipers)withasolidnodule(arrows)projectingfromthewallintothecysticportion.ColorDopplerdemonstratesflow(arrowheads)withinthesolidnodule(arrows)andwallofthetumorwithalowPIof0.69.Darklettersagainstalightbackground.MalignantOvarianTumorOvarianmucinouscystadenocarcinomawiththickseptationsandascites.Transvaginalimagesofovarydemonstratealarge,complexmass(calipers).Ascites(AS)waspresentintheabdomen.ColorDopplerdemonstratesflow(arrow)withinasolidportionofthetumorwithalowPIof0.42.OvarianFibromaOvarianfibroma.Imagesoftherightovarydemonstrateasolidmass(arrows)withhomogeneousechotexture.Themasshassonographicfeaturessimilartothoseofauterinefibroid.Sagittalimageoftheuterus(SAGUTarrows),whichwascompletelyseparatefromtheovarianmass.HydrosalpinxandTubo-ovarianabscessHydrosalpinx.Coronalimageofadilatedrightfallopiantube(CORRTTUBEarrows)showsatortuous,fluid-filledconfigurationwithfolds(arrowheads).Tubo-ovarianabscess.Transvaginalimagesofalarge,complexcysticmass(calipers)representingatubo-ovarianabscess.EndometrialpolypEndometrialpolypwithafeedingvessel.Sagittaltransvaginalviewoftheuterus(SAGUT)demonstratesahomogeneouslyechogenicmass(calipers)intheendometrium.ColorDopplerdemonstratesasinglefeedingvessel(arrow)intotheendometrialmass(arrowheads).Endometrialpolypsurroundedbyfluid.EndometrialcarcinomaAheterogeneousthickenedendometriumwithill-definedmargins(arrows).Thisappearanceishighlysuggestiveofendometrialcarcinoma,whichwasconfirmedviabiopsy.CDFIshowabundantbloodflowsignalofthelesionandexhibitlowerresistanceindexofbloodflow,whichisveryusefulfordiagnosisEndometrialhyperplasiaEndometrialcarcinoma(A60ywomanwithvaginalbleeding)HydatidMoleTransverseimageoftheuterusdemonstratesapoorlydefinedmulticysticmass(calipers,arrows)invadingtheposterioruterinewall.PowerDopplerimageshowshypervascularityofthemass(arrows)representingrecurrentmolartissue.ObstetricsEarlypregnancyDoubledecidualsignYolksacEmbryoNormalPregnancyat5-6WeeksGestationThegestationalsacisvisibleasroundedfluidcollectionswithintheendometrium,withnostructureswithinthem.Thegestationalsacissurroundedbytwoechogenicrings,aninnerring(shortarrows),andanouterring(longarrows).NormalPregnancyat5-6WeeksGestationGestationalsacat5.5weeksgestation.Thegestationalsac(arrowheads)containsayolksac(arrow),butnoembryoisyetvisible.NormalPregnancyat5-6WeeksGestation6.5weekembryo.Theembryo(arrow),5mminlength,isclearlyidentifiableadjacenttotheyolksac(arrowhead).Cardiacactivitywasseenwithintheembryoonreal-timesonography.NormalPregnancyat10-13WeeksGestationAnatomicstructuresinclude:theface(arrow)incoronal(A)andsagittal(B)views,ahand(D)four-chamberviewoftheheart(RVarrow,rightventricle;LVarrow,leftventricle;RAarrow,rightatrium;LAarrow,leftatrium)(E).EarlytwingestationTwingestationwithasingleplacentaYolksacembryoEctopicpregnancyEmptyuterusandfreefluidComplexfluidfromliquidandclottedbloodTubalring.FreepelvicfluidwithfloatingbowelPseudogestationalsacintheuterus(arrow)and2.5cmbrightlyechogenictubalringintheadnexaAbdominalectopicpregnancyAbdominalpregnancy.Sagittaltransabdominalviewofthepelvisandlowerabdomenrevealsagestationalsac(longarrows)containingafetus(shortarrow)andplacenta(PL),situatedsuperiortotheuterus(UT).EmbryonicDemiseTheyolksacappearsslightlyenlargedTheamnionisclearlyvisible.TherewasnocardiacactivitybytheM-ModeexaminationLargeemptydistortedintrauterinesacthatisbulgingtowardthecervicalcanalSecondandthirdtrimestersof

pregnancyLevelofbiparietaldiameterdemonstratesthepairedthalami(largearrows)withtheslit-likethirdventriclebetweenthem(smallarrows)AxialviewofthenormalcerebellumEyes,noseandlipsSecondandthirdtrimestersof

pregnancySpine.Longitudinalimageofentirespinedemonstratesparallelalignmentofposteriorossificationcentersuntiltheyconvergeatthesacrum(arrow).Transverseviewatthelevelofthefour-chamberviewoftheheartdemonstrateshomogeneouslungtissue(arrows)fillingthethoraxaroundtheheart(arrowhead).Secondandthirdtrimestersof

pregnancyTransverseviewoftheabdomenatthelevelofthestomach(S)andintrahepaticportionoftheumbilicalvein(arrowhead)asitjoinstheleftportalvein.Thespine(SP)isseenintransverseposteriorly.Transverseviewofthefetalabdomenattheleveloftheumbilicalcordinsertion(arrow)demonstratesanintactanteriorabdominalwall.Transverseviewofthefetalabdomendemonstratesakidney(arrows)oneithersideofthespine(SP).Secondandthirdtrimestersof

pregnancyThefemurlengthinthis20-weekfetus,hand,footPlacentaandamnioticfluidSecondandThirdtrimesterofpregnancyCongenitalFetal

AbnormaliesAnencephalyCephaloceleSpinabifidaHydrocephalyEsophagealatresiaDuodenalatresiaNonfetalabnormalitiesPlacentalabnormalityNormalplacentePlacentalabruptionandHematomaAcollectionofhypoechoicfluidliftstheedgeoftheplacenta(P)awayfromtheunderlyingmyometrium(M).Thefluidcollectioncontainslayeringhigh-attenuationmaterial(arrowhead),afindingconsistentwithblood.Placentalabruptionwithretroplacentalhematoma.Thereisahypoechoichematoma(longarrowandcalipers)liftingtheedgeoftheplacenta(shortarrow).PlacentalabruptionandHematomaPlacentalabruptionwithahematomathatismainlyunderthechorionicmembrane.Thereisahypoechoichematoma(HE)liftingtheedgeoftheplacenta(arrow)andthemembranes(arrowheads).Placentaprevia(L)TransvaginalUSimageobtainedat20weeksgestationshowsalow-lyingplacenta(P).Theplacentalmargincomestowithin0.7cmoftheinternalcervicalos.(R)TransvaginalUSimageobtainedat19weeksgestationshowsmarginalplacentaprevia.Theplacentaltip(T)islocatedimmediatelyattheinternalcervicalos(O)butdoesnotcoverit.P=bodyoftheplacenta.Placentaprevia(L)TransvaginalUSimageobtainedat19weeksgestationshowscompleteplacentaprevia.Theplacenta(P)entirelycoverstheinternalcervicalos(O).(R)TransabdominalUSimageobtainedat18weeksgestation.Theplacenta(P)entirelycoverstheinternalcervicalos(Oine).theumbilicalcord(Cine)insertsimmediatelyabovetheos.Cinf=uterinecervix.

PlacentalchorioangiomaPlacentalchorioangioma.Alargesolidmass(arrowheads)extendsfromthesurfaceoftheplacenta(arrow).OligohydramniosOligohydramniosinthefirsttrimester:This12weeksfetus(calipers)issurroundedbyvirtuallynoamnioticfluid.Thefetusdiedwithin1weekofthissonogram.OligohydramniosOligohydramniosinthelatterhalfofpregnancy:32weeksgestationdemonstrateslowamnioticfluidvolume.Deepestpocketmeasurementsintherightupperquadrant(RUQ),leftupperquadrant(LUQ),rightlowerquadrant(RLQ),andleftlowerquadrant(LLQ),yieldanamnioticfluidindexof4.2(1.2+3.0+0+0).PolyhydramniosExcessiveamnioticfluidvolume,orpolyhydramnios,canoccurwithanumberofmaternalandfetalabnormalities,includingesophageal,duodenal,andproximalsmallbowelobstruction;severebrainanomaliessuchasanencephaly;facialcleftsandtumors;andintrathoracicmasses.Moderatepolyhydramniosdeterminedbyamnioticfluidindex.At31weeksgestationdemonstratesincreasedamnioticfluidvolume,Deepestpocketmeasurementsin4quadrants,yieldanamnioticfluidindexof37.5(9.4+10.0+9.6+8.5).PolyhydramniosSeverepolyhydramnios:subjec