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
Uterine serosa layer: Linear highecho ;clear, smooth;
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.
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
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.
5. A complex mass
bleeding, pain
Uterine Locations of leiomyomas
Submucosal Erode into endomertial cavity – heavy bleeding;
infertility Intramural May enlarge to cause pressure on adjacent organs;
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
intramurous myoma
Subserous myoma intramurous myical myoma
M
UT Abundant tumor blood flow
RI 0.61
Submucous myoma with calcification
Color Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ；
Doppler spectrum：Medium resistance index，RI 0.6±0.1。
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
changes Degeneration occurs when fibroids outstrip their
blood supply; calcification May be pedunculated Clinical: enlarged uterus, profuse and prolonged
and ileum Anterior: bladder, ureters, ovaries,
fallopian tubes, uterus, and vagina
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
Common Diseases of Obstetrics and Gynecology
Gynecology ：Leiomyoma ；Carcinoma ;； Ovarian Tumors; Inflammatory mass ;etc.
Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.
Ultrasonography on Gynecology and Obstetrics
THE DA WINCI CODE
Sangreal--------uterus
NORMAL ANATOMY
Pelvic Cavity Posterior : Occupied by rectum, colon,
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
Ultrasonic performance
Two-dimensional：①Increased uterine body or
Form disorders； ②Spherical hypoechoic area in the uterine body ，Rear echo attenuation； ③With calcification or Cystic change, etc；④Signs of oppression；
Uterine Position
Midline anteversion: most common; degree of anteversion is bladder distention dependent
Right or left: normal variant in absence of pelvic masses
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
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.
below the os where peritoneum is reflected onto bladder Supported by levator ani muscles and pelvic fascia Round ligament keeps uterus in position
Normal size : 2~3(thick)×4~5(width)×7~8 cm(length)
Uterine longitudinal diameter
Uterus before and after the
Trail
Uterine wide diameter
width 4~5cm
before and after the Trail 2~3cm
the middle of the uterine cavity.
Fallopian Tube（输卵管）
Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovaries
The uterus Leiomyoma /Hysteromyoma
Characteristics of Leiomyomas
Most common pelvic tumor Smooth muscle cell composition Fibrosis occurs after atrophic of degenerative