妇产科疾病的超声诊断-ENGLISH

UltrasonographyonGynecologyandObstetricsLiuLipingSangreal--------uterusTHEDAWINCICODEPelvicCavityPosterior:Occupiedbyrectum,colon,andileumAnterior:bladder,ureters,ovaries,fallopiantubes,uterus,andvaginaNORMALANATOMYPre-inspection:ModeratebladderfillingUterusHollow,pear-shapedorganDividedintofundus,body,andcervixUsuallyanteflexedandantevertedCoveredwithperitoneumexceptanteriorlybelowtheoswhereperitoneumisreflectedontobladderSupportedbylevatoranimusclesandpelvicfasciaRoundligamentkeepsuterusinpositionUterinesizePrepubertal:3cmlongby0.5to1.0cmwideMenarcheal:8cmlongby4cmwidePostmenopausal:3.5to5.5cmlongby1to2cmwideNormalsize:2~3(thick)×4~5(width)×7~8cm(length)UterinelongitudinaldiameterUterinewidediameterUterusbeforeandaftertheTrailbeforeandaftertheTrail2~3cmwidth4~5cmUterinePositionMidlineanteversion:mostcommon;degreeofanteversionisbladderdistentiondependentRightorleft:normalvariantinabsenceofpelvicmassesRetroverted:entireorgandisplacedposteriorlyRetroflexed:bodydisplacedwithrespecttocervixUltrasonographyofnormaluterusUterineserosalayer:Linearhigh-echo;clear,smooth;Myometrium:Homogeneousmiddle-echo;Endometria:Themiddlelineofhighecho,aroundtheweakecho.Itiswellknownthattheendometriumchangesdynamicallyinresponsetocyclichormonalflux.UterineserosalayerMyometriumEndometriaNormaluterustransabdominalultrasonographyTransvaginalsagittalviewoftheuterus.Theroundedfundusisshowntowardtheleftoftheimagewiththeendometrialstriperummingthroughthemiddleoftheuterinecavity.MyometriumEndometriaUterineserosalayerFallopianTube（输卵管）Infundibulum:funnel-shapedlateraltubethatprojectsbeyondthebroadligamenttooverlietheovariesAmpulla:sidestpartofthetubewherefertilizationoccursIsthmus:hardestpart;liesjustlateraltotheuterusLength:12cm;suppliedbyovarionarteriesandveinsOvary（卵巢）AlmondshapedAttachedtobackofthebroadligamentbymesovarium;sometimescalledsuspensoryligamentoftheovaryLiesinovarianfossaFossaisboundedbyexternaliliacvessels,ureter,andobturatornerveReceivesbloodfromovarianarteryBlooddrainedbyovarianveinintoinferiorvenacavaonright;onleftbyovarianveinintolertrenalveinSonographyofthenormalovaryAnovoidhomogeneousechodensity;follicularcystsareoftenpresent.Thebestsonographicmarkerfortheovaryisidentificationofafollicularcyst,whichhastheclassicappearanceofbeingthinwalledandanechoicwiththrough-transmissionposteriorly.TransabdominalsagittalimageshowstheleftovaryposteriortotheurinarybladderTransvaginalsagittalimageoftheovaryovarianfollicleFollicularwallflowCommonDiseasesofObstetricsandGynecologyGynecology：Leiomyoma；Carcinoma;；OvarianTumors;Inflammatorymass;etc.Obstetrics：Naturalpregnancy；Abnormalpregnancy;etc.TheuterusLeiomyoma/HysteromyomaCharacteristicsofLeiomyomasMostcommonpelvictumorSmoothmusclecellcompositionFibrosisoccursafteratrophicofdegenerativechangesDegenerationoccurswhenfibroidsoutstriptheirbloodsupply;calcificationMaybepedunculatedClinical:enlargeduterus,profuseandprolongedbleeding,painUterineLocationsofleiomyomasSubmucosalErodeintoendomertialcavity–heavybleeding;infertilityIntramuralMayenlargetocausepressureonadjacentorgans;infertilitySubserosalMayenlargetocausepressureonadjacentorgansSubserousmyomaBroadligamentmyomaCervicalmyomaintramurousmyomaSubmucousmyomaUltrasonicperformanceTwo-dimensional：①IncreaseduterinebodyorFormdisorders；②Sphericalhypoechoicareaintheuterinebody，Rearechoattenuation；③WithcalcificationorCysticchange,etc；④Signsofoppression；ColorDoppler：Tumoraroundwiththebloodflowsignalintheshapeofringorsemi-circularring；Dopplerspectrum：Mediumresistanceindex，RI0.6±0.1。intramurousmyomaSubserousmyomaintramurousmyomaSubserousmyomaCervicalmyomaAbundanttumorbloodflowMUTRI0.61SubmucousmyomawithcalcificationTeratomaDermoidTummors（卵巢良性囊性畸胎瘤/皮样囊肿)Pathology：derivesfromgermcell，themostcommonovarianneoplasm,constituting20%ofovariantumors.upto20%arebilateral.About80%occurinwomenofchildbearingage.Sizerangesfromsmallto40cmUnliateral,roundtoovalmassContainsfaty,sebaceousmaterial,hair,cartilage,bone,teethClinical:asymptomatictoabdominalpain,enlargementandpressure;pedunculated,subjecttotorsionSonography:Cystic/complex/solidmass,echogeniccomponents;acousticshadowingSpecialUltrasoundFindings:1.Acysticmass:withanechogenicmuralnodule2.Apastesign：particulateliptinite3.Afluffofhairsign4.Afat-fluidlevelsign：withfluidlevelinthecyst,fatabove,fluidbelow.5.AcomplexmasscysticteratomaofovaryAcysticmassPastesignFluffofhairsignPastesignFat-fluidlevelsignAcomplexmassA8yearsoldgirl,cuttingoffathreekilogramsbenignteratomaTheroleofUltrasoundinObstetricsTRIMESTERSFirsttrimester=0to12weeksofgestationSecondtrimester=13to26weeksofgestationThirdtrimester=27to42weeksofgetsationPosttermpregnancy=42weeksofgestationIndicationsforFirst-TrimesterSonographyConfirmpresenceofintrauterinepregnancyEvaluateforsuspectedectopicpregnancyDefinecauseofvaginalbleedingDeterminegestationalageConfirmsuspectedmultiplegestationsAidininvasiveproceduresEvaluatepelvicmassesDetectuterineabnormalitiesNaturalpregnancyNonagepregnancy(First-Trimes