basic gynaecolgoy ultrasound: basic knowledge

8/12/2019 Basic Gynaecolgoy Ultrasound: Basic knowledge

http://slidepdf.com/reader/full/basic-gynaecolgoy-ultrasound-basic-knowledge 1/51

Chok Chin Nam

Cathy Heng Siang Ting

Ultrasound

Base on sound wave reflection at the ultrasonicfrequency (2 to 18 megahertz).

Non ionizing, no radiationUltrasound wave produced from transducer reflectedupon hitting tissue echo vibrates the transducer software interpret the sound wave.

Often require bladder window for better accoustictransducibility if TAS is performed.

Potential uses for ultrasound in gynaecology 1:

Early Pregnancy Loss Assessment of adnexal pelvic masses

Compound B scan Doppler vessel studies

Diagnosis of polycystic ovaries

Investigation of postmenopausal bleeding Imaging and measure of endometrial thickness

Investigation of menorrhagia Fibroids and adenomyosis

Monitoring of follicle number and growth for IVF Egg recovery for IVF and ICSI Evaluation of pelvic pain

A limited role

Screening for ovarian cancer Too many false positives

Potential uses for ultrasound in gynaecology 2:

IUCD and Implanon location

Treatment of ovarian cysts (aspiration) and ectopicpregnancy (methotrexate)

Saline hysterography for delineation of the uterine cavity

Tubal patency studies in infertility

Evaluation of primary amenorrhoea

2 types of probe. Abdominal

Lower Frequency

3.5 MHz (2-5 MHz) Penetrate Deeper

Poor Distal Resolution

Large field

The full bladder servesas an acoustic windowand pushes the bowel

out of the sound path

Vaginal

Higher Frequency

7.5 MHz (5-8MHz) 6-8 cm Penetration

Excellent Resolution

Limited field

Transabdominal TECHNIQUES Supine position

A full bladder willprovide sonographic

window

3.5 MHz curvilineartransducer

Place transducer in the

sagittal plane just abovethe pubic bone

Locate the long-axis ofuterus and sweep fromside to side

Turn transducer 90degrees counter-clockwise

Locate the short-axis of

the uterus and anglecephalad and caudad

Goal is to see the entireuterus

TRANSVAGINAL TECHNIQUES Supine lithotomy

position

5.0-7.5 MHz

intravaginal transducer Need to apply gel to the

transducer andtransducer cover

Have assistant tochaperone

With locator anterior,scan the long-axis of theuterus

Transducer does notneed to be inserted allthe way to the cervix

Turn transducer 90degrees counter-

clockwise to scan theshort-axis of the uterus

Goal is to see the entireuterus

Indication Uterine pathology

Adnexal pathology

Bleeding in early pregnancy Ovary phase determination

Specific types of USG Hysterosonography.

USG Doppler.

UTERUS

Anteverted uterus: fundus towards same side as bladder

Retroverted uterus : fundus opposite side from bladder

Uterine pathology Fibroid

Endometrial Hyperplasia

Endometrial Ca Adenomyosis

Uterine leiomyoma

Transvaginal ultrasound is preferable, but large fibroidmight be better with TAS.

Fibroid is hypoechogenic compare to normalmyometrium.

Submucosal fibroid

Endometrial thickening

cyclical change during menstrual cycle

endometrial hyperplasia endometrial polyp

endometrial carcinoma

medications : HRT

Endometrial polyp

Visual can be enhanced via Doppler.

Endometrial thickeningIn the productive period, an endometrial

thickness of up to 14 mm may be considered normal andup to 5 mm post-menopausally

Sign of Endometrial Cancer (HPE exclusion) Higher possibility if ET > 10 mm compare to if < 5 mm

ENDOMETRIAL SCAN Double wall thickness

measurement (mm)

Immediate 1 - 4

Proliferative 7 - 10

Secretory 8 - 16

Endometrium Ashermann syndrome

Bands of calcification(hyperechogenic area)

Adenomyosis Enlarged Uterus

Thickened myometrium

Areas of decreased echogenicity(smooth musclehyperplasia)

Myometrial cystic space(haemorrhagic foci)

IUCD LOCALIZATION Proper Positioning

Loss IUCD

Perforation

Not > 20 mmIndicate Proper Positioning

Adnexal massNormal ovary size 2 × 2 × 3cm

Assessment includeds:

• Mobility

• Septation

• Wall structure• Pain

• Echogenicity

colour Doppler can beuse for :identification ofblood vessels within the

cyst wall and septa, within solid componentsand papillaryprojections.

Polycystic ovarian disease.

OVARIAN FOLLICLES (FUNCTIONAL)Phase Follicle Size

Follicular 2- 5 mm

DF (Day 10) 10 mm

Pre-ovulatory 20-24 mm

Corpus Luteum < 30 mm

Endometriotic cyst

Ovarian Tumour Characteristic of ultrasonic appearance suggestive of

malignancy:

Multilocular cyst

Solid areas Papillary projection

bilateral lesions

Ascites Intra-abdominal metastases

Large tumour >10cm

Thick, irregular wall

OVARIAN CYST Dysfunctional Cyst

HemorrhagicCyst/corpus luteum cyst

ConservativeManagement withFollow up 3/12

DERMOID CYST

Pelvic inflammatory disease

Ectopic pregnancy Abnormal implantation (extra uterine) of the

developing embryo 98% in the fallopian tube (ampullary)

Suspected when thickened endometrial lining (decidua)but without gestational sac (UPT +ve), with free fluid inPOD

Look for yolk sac

Fetal pole and HR outside uterine cavity-confirmthe diagnosis

A gestational sac outside the uterus with or without fetalheart beat

An adnexal mass which may be echo filled or hypoechoic with an adnexal ring.

A possible decidual cast in the uterus.(pseudosac)

Substantial fluid in the pouch of Douglas or paracolic

gutters or sub hepatic space, due to haemoperitoneuma serum β-hCG greater than 1,500 – 2,000 without

evidence of a gestational sac by transvaginalultrasound represents an ectopic pregnancy

Pesudosac vs gestational sac

Double decidual sign

Molar Pregnancy

Snow storm appearance due to vesicles Bilateral theca lutein cyst

Missed miscarriage Fetal pole > 6 mm with no fetal heart activity.

Gestation sac diameter 20 mm with no fetal poleoryolk sac

Abnormal hyperechoic material

Irregular gestational sac.

Complete miscarriage Endometrial thickness <15mm

No evidence of retained tissue

Incomplete miscarriage•

Heterogenous tissues sac distorting midlineendometrial echo• Any endometrial thickness

Threatened miscarriage

+ Fetal pole with heart echo

+ IUGS

+/-Subchorionic Haematoma

Subchorionic haematoma

Saline infusion Sonohysterography

(SIS) To detect abnormalities of the uterus and

endometrium

Abnormal uterine bleeding, infertility, recurrentspontaneous miscarriage, congenital abnormalities ofthe uterus, preoperative and postoperative evaluationof the uterine cavity, suspected intrauterine adhesions(synechiae or scar tissue)

Using Insemination catheter 5-15 ml saline into theUterine Cavity

Thank you!!!

basic gynaecolgoy ultrasound: basic knowledge

Documents

isuog basic training · 2019-02-06 · basic training isuog...

basic ultrasound 2013 cachard archamps

basic pig knowledge

basic physics of ultrasound - ers-education · brief...

basic principles of ultrasound imaging

sheffield basic transvaginal ultrasound course in obstetrics...

windows basic knowledge

basic general knowledge

[radio 250] lec 09 basic ultrasound (1).pdf

ultrasound study guide technical knowledge o · ultrasound...

basic ultrasound - c.ymcdn.com · pdf filebasic ultrasound...

introduction to ultrasound module -...

basic gynae ultrasound

basic principles of ultrasound and the use of lung

basic physics ultrasound

basic ultrasound for clinicians 2005

chapter one focused—basic ultrasound principles and...

basic ultrasound of the knee

basic principles of ultrasound imaging system design

basic knowledge