妇产科疾病的超声诊断2011-ENGLISH
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妇产科疾病的超声诊断
and ileum Anterior: bladder, ureters, ovaries,
fallopian tubes, uterus, and vagina
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Pre-inspection : Moderate bladder filling
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Uterus
Hollow, pear-shaped organ
Menarcheal: 8 cm long by 4 cm wide
Postmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wide
Normal size : 2~3(thick)×4~5(width)×7~8 cm(length)
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Uterine longitudinal diameter
on right; on left by ovarian vein into lert renal vein
sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and
obturator nerve Receives blood from ovarian artery Blood drained by ovarian vein into inferior vena cava
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Ultrasonography of normal uterus
Uterine serosa layer: Linear highecho ;clear, smooth;
fallopian tubes, uterus, and vagina
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3
Pre-inspection : Moderate bladder filling
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4
Uterus
Hollow, pear-shaped organ
Menarcheal: 8 cm long by 4 cm wide
Postmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wide
Normal size : 2~3(thick)×4~5(width)×7~8 cm(length)
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6
Uterine longitudinal diameter
on right; on left by ovarian vein into lert renal vein
sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and
obturator nerve Receives blood from ovarian artery Blood drained by ovarian vein into inferior vena cava
编辑版ppt
9
Ultrasonography of normal uterus
Uterine serosa layer: Linear highecho ;clear, smooth;
妇产科超声疾病的超声诊断
能量多普 勒显示基 底动脉环
胎头光环
胎儿颜面部
胎儿头面部
2、胎儿胸廓与胎心：
胎心节律性搏动
胎儿主动脉及其 分支彩色血流
3、胎儿肝、胆囊、肾和膀胱：
4、胎儿肢体、脊柱：
5、胎盘、脐带与羊水：
胎盘的位置和功能； 羊水深度 正常4~7cm， ＞8cm＜10cm偏多， ＞10cm为过多， ＞2cm＜3cm为偏少， ＜2cm为羊水过少； 彩色多普勒超声能清晰显示脐带血流， 对脐带绕颈能作出及时诊断。
本节课的重点内容
1、掌握正常子宫的声像特点； 2、掌握正常妊娠的超声检测指标； 3、掌握子宫肌瘤、异位胎盘的声像特点。 4、熟悉巧克力囊肿、良性畸胎瘤的声像特 点。 5、了解浆液性囊腺瘤和粘液性囊腺瘤的鉴 别诊断要点。
子宫肌瘤动态图像
子宫肌瘤
肌瘤周边和中心见丰富 的彩色血流信号
第二节 卵
主要疾病的超声诊断
巢
(一)卵巢非赘生性囊肿：(non-neoplastic cyst of ovary)
巧克力囊肿： 本病由于子宫内膜异位到卵巢而产生，因卵巢内异 位子宫内膜周期性出血潴留，逐渐形成囊肿，由于陈旧 性出血的颜色如巧克力样，故又名巧克力囊肿，此病较 常见。
(1)浆膜下肌瘤； (2) 粘膜下肌瘤： (3)肌壁间肌瘤： (4) 宫颈肌瘤： (5) 阔韧带肌瘤。
[声像图特征]
①子宫非对称性增大，形态失常。 ②肿块边界清楚，边缘规则。 ③瘤体回声多样，有：减弱型、增强型和混合型。 ④肌瘤变性声像图表现： A 玻璃样变：回声明显减低； B 液化或囊性变：可见大小不等的囊状无回声区 ，有些酷似囊肿； C 钙化 ：有脂肪变性时，可以看到区域性或大片 均匀强回声；有钙化时可见强回声钙化斑伴声影。
妇产科疾病超声诊断
妇产科疾病超声诊断1．女性内生殖器官的应用解剖特点是什么？女性内生殖器官是超声检查的要紧盆腔脏器，包括子宫、部分阴道、输卵管和卵巢。
（1）子宫：子宫为一中空的厚肌性器官，呈前后略扁的倒置梨形。
子宫可分三部分，上端向上穹突的部分称为宫底，它位于两侧输卵管子宫口的上方；下端狭窄部分为子宫体；子宫颈为与子宫体相接的圆柱形，被阴道分为上下两部。
突入阴道内的部分为子宫颈阴道部，约占宫颈的1/3，子宫颈在阴道以上的部分为子宫颈阴道上部，子宫颈阴道上部与子宫体相接的狭细部分为子宫峡部，非妊娠期该部分不明显，长约1cm。
子宫的内脏狭小，称子宫腔，可分上、下两部。
上部位于子宫底与子宫体内，称为真正的宫腔，呈三角形，底向上，尖朝下。
下部在子宫颈内，称子宫颈管。
子宫颈管有两个开口，开口于宫腔者为宫颈内口，开口于阴道者为宫颈外口。
子宫位于盆腔中央，前为膀胱，后为直肠。
子宫与膀胱间形成子宫膀胱凹，子宫与直肠间形成子宫直肠凹。
正常子宫被四对韧带固定，多数呈前倾前屈位，也可为中间位或后倾后屈位。
子宫壁由外向内为浆膜层、肌层和粘膜层。
浆膜层又称为子宫外膜，为包在子宫表面的腹膜。
肌层由纵横交错的子宫平滑肌构成，平均厚约0.8cm。
粘膜层又称子宫内膜，分功能层和基底层两层，功能层随月经周期和妊娠期变化。
子宫随年龄的增长和内分泌的阻碍。
其大小、形状、宫体与宫颈的比例均有明显的变化。
小儿稚嫩子宫长约2—3cm，宫体与宫颈之比约为1∶2；成人未产型子宫长约5.5—8m，宫体与宫颈之比为1∶1；经产妇子宫长约9—9.5cm，宫体与宫颈之比为2∶1；绝经期妇女子宫逐步萎缩，在60岁后复原回复到稚嫩子宫形状。
（2）输卵管：输卵管为成对细长弯曲的管状结构，近端与子宫角相通，远端游离，长约12cm。
输卵管为卵子与精子相遇场所。
输卵管分为4个部分：①间质部：亦称子宫角部，此处管腔甚细，为输卵管子宫壁内部分；③峡部：与间质部相连，管腔略变大；③壶腹部：为管腔最大部分为异位妊娠最好发部位；④伞部：开口于腹腔，呈喇叭状。
妇产科疾病的超声诊断ENGLISH
妇产科疾病的超声诊断ENGLISH
Ultrasonography of normal uterus
l Uterine serosa layer: Linear highecho ;clear, smooth;
l Myometrium: Homogeneous middleecho ;
l 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.
Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.
妇产科疾病的超声诊断ENGLISH
The uterus Leiomyoma /Hysteromyoma
妇产科疾病的超声诊断ENGLISH
Characteristics of Leiomyomas
Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through
the middle of the uterine cavity. 妇产科疾病的超声诊断ENGLISH
Uterus
l Hollow, pear-shaped organ l Divided into fundus, body, and cervix l Usually anteflexed and anteverted l Covered with peritoneum except anteriorly
Ultrasonography of normal uterus
l Uterine serosa layer: Linear highecho ;clear, smooth;
l Myometrium: Homogeneous middleecho ;
l 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.
Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.
妇产科疾病的超声诊断ENGLISH
The uterus Leiomyoma /Hysteromyoma
妇产科疾病的超声诊断ENGLISH
Characteristics of Leiomyomas
Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through
the middle of the uterine cavity. 妇产科疾病的超声诊断ENGLISH
Uterus
l Hollow, pear-shaped organ l Divided into fundus, body, and cervix l Usually anteflexed and anteverted l Covered with peritoneum except anteriorly
妇科疾病的超声诊断-英文版
Ovary（卵 巢）
Almond shaped Attached to back of the broad ligament by mesovarium;
sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and
Ultrasonography of normal uterus
Uterine selear, smooth;
Myometrium: Homogeneous middleecho ;
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.
Transabdominal sagittal image shows the left ovary posterior to the urinary bladder
ovarian follicle
Transvaginal sagittal image of the ovary
Follicular wall flow
obturator nerve Receives blood from ovarian artery Blood drained by ovarian vein into inferior vena cava
on right; on left by ovarian vein into left renal vein
妇科疾病的超声诊断英文课件
longitudinal diameter
Anteroposterior diameter
wide diameter
width 4~5cm
Anteroposterior diameter 2~3cm
Uterine Position
Midline anteversion: most common; degree of anteversion is bladder distention dependent
Sonography of the normal ovary
An ovoid homogeneous echodensity; follicular cysts are often present.
Ampulla: sidest part of the tube where fertilization occurs
Isthmus: hardest part; lies just lateral to the uterus
Length: 12 cm; supplied by ovarion arteries and veins
Uterine serosa layer
Endometria
Myometrium
Normal uterus transabdominal ultrasonography
Myometrium
Endometria
Uterine serosa layer
Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe running through
妇科疾病超声诊断
妇科疾病超声诊断妇科疾病及常见疾病妇科疾病是指发生在女性生殖器官或相关器官的疾病，包括盆腔炎、阴道炎、乳腺增生、子宫肌瘤、子宫内膜增生、卵巢囊肿等常见疾病。
这些疾病如果无法及时发现和治疗，会对女性的身体健康造成较大的影响。
因此，做好妇科疾病的早期诊断和治疗显得尤为重要。
妇科超声诊断妇科超声具有无创、安全、快速、简便等优点，成为妇科常用的无创检查方法之一。
通过超声诊断，可以快速、准确地获取患者盆腔和生殖器官的各种信息，帮助医生对妇科疾病进行诊断和分析。
超声检查方法常用的妇科超声检查方法有以下几种：•外阴超声：检测外阴及阴唇的肿块、凸起和囊肿，患有外生殖器疖肿和内痔时也可检出；•阴道超声：诊断子宫内膜增生、子宫内膜息肉、子宫肌瘤、黏液性卵巢囊肿、子宫腺肌症等疾病；•子宫输卵管超声：检查子宫、卵巢、输卵管及其周围的疾病；•经阴道超声：比超声方向对准病灶要准确，能清晰地观察子宫、卵巢、输卵管等疾病。
超声检查注意事项妇科超声诊断是一种安全、无创的检查方法。
但在做超声之前，需要注意以下事项：•做好个人卫生；•不要在月经期或性生活后7天内检查；•注意排气，尽可能保持膀胱充盈；•患有前列腺炎、盆腔炎等感染性疾病的患者，建议就诊前用药治疗。
常见疾病的超声诊断方法子宫内膜增生子宫内膜增生是女性常见疾病之一，常见于高龄女性及更年期前后的女性。
其主要症状为月经不规律、经期延长、月经量增多等。
妇科超声是鉴别子宫内膜息肉和子宫内膜增生的最常用方法，其具有安全、无创、准确等优点。
具体检查方法如下：•采用阴道探头；•观察子宫体和子宫颈；•观察子宫内膜厚度；•分析子宫内膜强度及其形态。
卵巢囊肿卵巢囊肿是由卵巢内排卵的过程中形成的液态肿块。
其主要症状有月经不畅、腹部不适等。
妇科超声可以准确地检测卵巢囊肿的情况，具体方法如下：•采用经阴道探头；•观察卵巢的大小及形态；•观察囊肿的大小及形态；•观察其内部的液体或分隔情况。
子宫肌瘤子宫肌瘤是女性常见的一种肌肉瘤，患者主要症状常为月经不规律、月经疼痛、腹部肿块等。
企业诊断-妇产科疾病的超声诊断ENGLISH 精品
Right or left: normal variant in absence of pelvic masses
Retroverted: entire organ displaced posteriorly Retroflexed: body displaced with respect to cervix
Sonography of the normal ovary
An 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.
Uterine serosa layer
Endometria
Myometrium
Normal uterus transabdominal ultrasonography
Myometrium
Endometria
Uterine serosa layer
Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through
Teratoma Dermoid Tummors
Retroverted: entire organ displaced posteriorly Retroflexed: body displaced with respect to cervix
Sonography of the normal ovary
An 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.
Uterine serosa layer
Endometria
Myometrium
Normal uterus transabdominal ultrasonography
Myometrium
Endometria
Uterine serosa layer
Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through
Teratoma Dermoid Tummors
妇产科疾病的超声诊断2011
Sonography of the normal ovary
An 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.
Ampulla: sidest part of the tube where fertilization occurs
Isthmus: hardest part; lies just lateral to the uterus
Length: 12 cm; supplied by ovarion arteries and veins
Sonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowing
Special Ultrasound Findings:
1. A cystic mass: with an echogenic mural nodule
Retroverted: entire organ displaced posteriorly Retroflexed: body displaced with respect to cervix
Ultrasonography of normal uterus
妇产科疾病的超声诊断-ENGLISH
infertility Subserosal May enlarge to cause pressure on adjacent organs
intramurous myoma
Submucous myoma
Subserous myoma
Broad ligament myoma
Cervical myoma
Ovary（卵 巢）
Almond shaped Attached to back of the broad ligament by mesovarium;
sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and
Ampulla: sidest part of the tube where fertilization occurs
Isthmus: hardest part; lies just lateral to the uterus
Length: 12 cm; supplied by ovarion arteries and veins
Color Doppler：Tumor around with the blood flow signal in the shape of ቤተ መጻሕፍቲ ባይዱing or semi-circular ring ；
Doppler spectrum：Medium resistance index，RI 0.6±0.1。
Uterine serosa layer
Endometria
intramurous myoma
Submucous myoma
Subserous myoma
Broad ligament myoma
Cervical myoma
Ovary（卵 巢）
Almond shaped Attached to back of the broad ligament by mesovarium;
sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and
Ampulla: sidest part of the tube where fertilization occurs
Isthmus: hardest part; lies just lateral to the uterus
Length: 12 cm; supplied by ovarion arteries and veins
Color Doppler：Tumor around with the blood flow signal in the shape of ቤተ መጻሕፍቲ ባይዱing or semi-circular ring ；
Doppler spectrum：Medium resistance index，RI 0.6±0.1。
Uterine serosa layer
Endometria
妇产科疾病超声诊断
一、妇产科疾病超声诊断1．女性内生殖器官的应用解剖特点是什么？女性内生殖器官是超声检查的主要盆腔脏器，包括子宫、部分阴道、输卵管和卵巢。
（1）子宫：子宫为一中空的厚肌性器官，呈前后略扁的倒置梨形。
子宫可分三部分，上端向上穹突的部分称为宫底，它位于两侧输卵管子宫口的上方；下端狭窄部分为子宫体；子宫颈为与子宫体相接的圆柱形，被阴道分为上下两部。
突入阴道内的部分为子宫颈阴道部，约占宫颈的1/3，子宫颈在阴道以上的部分为子宫颈阴道上部，子宫颈阴道上部与子宫体相接的狭细部分为子宫峡部，非妊娠期该部分不明显，长约1cm。
子宫的内脏狭小，称子宫腔，可分上、下两部。
上部位于子宫底与子宫体内，称为真正的宫腔，呈三角形，底向上，尖朝下。
下部在子宫颈内，称子宫颈管。
子宫颈管有两个开口，开口于宫腔者为宫颈内口，开口于阴道者为宫颈外口。
子宫位于盆腔中央，前为膀胱，后为直肠。
子宫与膀胱间形成子宫膀胱凹，子宫与直肠间形成子宫直肠凹。
正常子宫被四对韧带固定，多数呈前倾前屈位，也可为中间位或后倾后屈位。
子宫壁由外向内为浆膜层、肌层和粘膜层。
浆膜层又称为子宫外膜，为包在子宫表面的腹膜。
肌层由纵横交错的子宫平滑肌构成，平均厚约0.8cm。
粘膜层又称子宫内膜，分功能层和基底层两层，功能层随月经周期和妊娠期变化。
子宫随年龄的增长和内分泌的影响。
其大小、形态、宫体与宫颈的比例均有明显的变化。
小儿幼稚子宫长约2—3cm，宫体与宫颈之比约为1∶2；成人未产型子宫长约—8m，宫体与宫颈之比为1∶1；经产妇子宫长约9—9.5cm，宫体与宫颈之比为2∶1；绝经期妇女子宫逐渐萎缩，在60岁后恢复回复到幼稚子宫形态。
（2）输卵管：输卵管为成对细长弯曲的管状结构，近端与子宫角相通，远端游离，长约12cm。
输卵管为卵子与精子相遇场所。
输卵管分为4个部分：①间质部：亦称子宫角部，此处管腔甚细，为输卵管子宫壁内部分；③峡部：与间质部相连，管腔略变大；③壶腹部：为管腔最大部分为异位妊娠最好发部位；④伞部：开口于腹腔，呈喇叭状。
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Ultrasonography of normal uterus
Uterine serosa layer: Linear highecho ;clear, smooth; Myometrium: Homogeneous middleecho ; 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 Locations of leiomyomas
Submucosal Erode into endomertial cavity – heavy bleeding; infertility Intramural May enlarge to cause pressure on adjacent organs; infertility Subserosal May enlarge to cause pressure on adjacent organs
Teratoma Dermoid Tummors
（卵巢良性囊性畸胎瘤/皮样囊肿)
Pathology ：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.
Sonography of the normal ovary
An 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.
Special Ultrasound Findings:
1. A cystic mass: with an echogenic mural nodule 2. A paste sign：particulate liptinite 3. A fluff of hair sign 4. A fat-fluid level sign：with fluid level in the cyst, fat above, fluid below.
Ovary（卵
巢）
Almond shaped Attached to back of the broad ligament by mesovarium; sometimes called suspensory ligament of the ovary Lies in ovarian fossa Fossa is bounded by external iliac vessels, ureter, and obturator nerve Receives blood from ovarian artery Blood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal vein
Size ranges from small to 40 cm Unliateral,round to oval mass Contains faty,sebaceous material, hair, cartilage, bone, teeth Clinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsion Sonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowing
Pre-inspection : Moderate bladder filling
Uterus
Hollow, pear-shaped organ Divided into fundus, body, and cervix Usually anteflexed and anteverted Covered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladder Supported by levator ani muscles and pelvic fascia Round ligament keeps uterus in position
Common Diseases of Obstetrics and Gynecology
Gynecology ：Leiomyoma ；Carcinoma ;； Ovarian Tumors; Inflammatory mass ;etc. Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.
Transabdominal sagittal image shows the left ovary posterior to the urinary bladder
ovarian follicle
Transvaginal sagittal image of the ovary
Follicular wall flow
Uterine size
Prepubertal : 3 cm long by 0.5 to 1.0 cm wide Menarcheal: 8 cm long by 4 cm wide Postmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wide Normal size : 2~3(thick)×4~5(width)×7~8 cm(length)
Ultrasonography on Gynecology and Obstetrics
Liu Liping
THE DA
WINCI CODE
Sangreal--------uterus
NORMAL ANATOMY
Pelvic Cavity Posterior : Occupied by rectum, colon, and ileum Anterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vagina
Fallopian Tube（输卵管）
Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovaries Ampulla: sidest part of the tube where fertilization occurs Isthmus: hardest part; lies just lateral to the uterus Length: 12 cm; supplied by ovarion arteries and veins
Uterine longitudinal diameter
Hale Waihona Puke Uterus before and after the Trail Uterine wide diameter
width 4~5cm
before and after the Trail 2~3cm
Uterine Position
Midline anteversion: most common; degree of anteversion is bladder distention dependent Right or left: normal variant in absence of pelvic masses Retroverted: entire organ displaced posteriorly Retroflexed: body displaced with respect to cervix
intramurous myoma
Subserous myoma
intramurous myoma
Subserous myoma
Cervical myoma
M
UT
Abundant tumor blood flow
RI 0.61
Submucous myoma with calcification
The uterus Leiomyoma /Hysteromyoma
Characteristics of Leiomyomas
Most common pelvic tumor Smooth muscle cell composition Fibrosis occurs after atrophic of degenerative changes Degeneration occurs when fibroids outstrip their blood supply; calcification May be pedunculated Clinical: enlarged uterus, profuse and prolonged bleeding, pain