is ultrasonography helpful in
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Is UltrasonographyIs Ultrasonography helpfulhelpful inin
Gynecologic DiagnosisGynecologic Diagnosis ? ?
Azza Al-YamaniAzza Al-Yamani Prof. of Obstetrics andProf. of Obstetrics and
GynecologyGynecology
The objectives of this slide show areThe objectives of this slide show are : :
** Know the principles of Ulrtasuond imagingKnow the principles of Ulrtasuond imaging . .** Be familial with the US Be familial with the US normalnormal appearance of appearance of
different pelvic structuresdifferent pelvic structures . .** Be able to interpret US images in commonBe able to interpret US images in common
gynecologic pathologygynecologic pathology . .** Be able to differentiate between USBe able to differentiate between US
appearance of appearance of benignbenign and and malignantmalignant pelvic pelvic massesmasses . .
** Know the advantages of Know the advantages of TV/ USTV/ US over over abdominal transducers in Gynabdominal transducers in Gyn . .
US imaging is a simple and noninvasiveUS imaging is a simple and noninvasive
procedure that has the advantage of avoidingprocedure that has the advantage of avoiding radiation hazardsradiation hazards . .
It is especially helpful in patients in whomIt is especially helpful in patients in whom pelvic exam. is difficult as pelvic exam. is difficult as childrenchildren , ,virginsvirgins & &
incooperativeincooperative . .
Doppler sonographyDoppler sonography Can measure the velocity profile of blood flowing Can measure the velocity profile of blood flowing through pelvic bl. vessels to differentiate benign through pelvic bl. vessels to differentiate benign
from malignant adnexal massesfrom malignant adnexal masses . .
FinallyFinally
TV/US can be used to assistTV/US can be used to assist in performingin performing invasive gynecological procedures asinvasive gynecological procedures as
vaginal oocyte collectionvaginal oocyte collection . .
Transvaginal ultrasound (TV/US) has the advantageTransvaginal ultrasound (TV/US) has the advantage over the abdominal US in gynecology , becauseover the abdominal US in gynecology , because
the close proximity of the intravaginal trancducerthe close proximity of the intravaginal trancducer allows for high – frequency scanning and betterallows for high – frequency scanning and better
resolution of the pelvic organsresolution of the pelvic organs. .
However , every TV/US examination should beHowever , every TV/US examination should be preceded by transabdominal imagingpreceded by transabdominal imaging. .
TechnologyTechnology
Intermittent high – frequency sound waves areIntermittent high – frequency sound waves are generated by applying an alternating electricgenerated by applying an alternating electric
current to a transducer made of a current to a transducer made of a piezoelectricpiezoelectric materialmaterial . .
The transducer is connected to the abdominalThe transducer is connected to the abdominal
wall by placing a water –soluble gel on the skinwall by placing a water –soluble gel on the skin to diminish the loss of US waves at the interfaceto diminish the loss of US waves at the interface
between the transducer and the skinbetween the transducer and the skin . .
The transducer emits a pulse of The transducer emits a pulse of sound wavessound waves that passes through structures of different tissuethat passes through structures of different tissue
densities , some of the energy proportional todensities , some of the energy proportional to the the difference difference in in densitiesdensities is reflected or echoed is reflected or echoed
back to the transducerback to the transducer . .
This in turn ,stimulates the transducer to generateThis in turn ,stimulates the transducer to generatea small electrical voltage that is then amplifieda small electrical voltage that is then amplified
and displayed on a screenand displayed on a screen . .
Clinical ApplicationsClinical Applications in gynecologyin gynecology
The use of ultrasonography in the diagnosisThe use of ultrasonography in the diagnosis of gynecological lesions can be summarizedof gynecological lesions can be summarized
in 3 indicationsin 3 indications : : ))11 ( (Pelvic mass differentiationPelvic mass differentiation
* *UterineUterine masses masses . . * *OvarianOvarian masses masses . .
cystic or solidcystic or solid * *AdnexalAdnexal masses masses . .
cystic or solidcystic or solid . .
))22 ( (evaluation of the uterine cavityevaluation of the uterine cavity including IUCD localizationincluding IUCD localization . .
))33 ( (Early pregnancy complicationsEarly pregnancy complications including ectopic pregnancyincluding ectopic pregnancy . .
))11 ( (Pelvic MassesPelvic Masses Uterine massesUterine masses
11 . .Leiomyoma Leiomyoma ( ( fibroidfibroid ) ) • •more in the midline positionmore in the midline position . . • •contiguous with the uteruscontiguous with the uterus . . • •well definedwell defined . . • •homogeneous ,hypoechoic masshomogeneous ,hypoechoic mass . . • •may have small cysts ( degeneration)may have small cysts ( degeneration) , ,
or calcified areas (calcification)or calcified areas (calcification) . .
N. Secretory N. proliferativeN. Secretory N. proliferative endometrium endometriumendometrium endometrium
anterior wall fibroidanterior wall fibroid
pedunculated subserous fibroidpedunculated subserous fibroid
Broad ligament fibroidBroad ligament fibroid
Interamural fibroidInteramural fibroid
Calcified fibroidCalcified fibroid
22 . .endometrial polypendometrial polyp
• •discrete mass (es) within the uterine cavitydiscrete mass (es) within the uterine cavity..••enlargement of the uterusenlargement of the uterus . .
• •prominent endometrial echo complex withprominent endometrial echo complex with
saline contrastsaline contrast . .
endometrial polypendometrial polyp
33 . .AdenomyosisAdenomyosis
• •uterine enlargementuterine enlargement . . • •normal central endometrial echonormal central endometrial echo . . • •honey comb appearancehoney comb appearance . .
44 . .endometrial carcinomaendometrial carcinoma
• •very important that it may not alter thevery important that it may not alter the uterine echo patternuterine echo pattern . .
• •prominent endometrial echo complexprominent endometrial echo complex > >4mm in postmenopausal woman4mm in postmenopausal woman . . • •loss of the normal endometrial / myometrialloss of the normal endometrial / myometrial
junctionjunction . . • •pyometria , or hematometriapyometria , or hematometria . .
Pyometria endometrial carcinomaPyometria endometrial carcinoma
Ovarian massesOvarian masses
11..CysticCystic cystic mass free in the adenexal areacystic mass free in the adenexal area
not related to the uterusnot related to the uterus . .
a) a) BenignBenign < • < •5cm ( cystic ovary ) physiological5cm ( cystic ovary ) physiological . .
• •walls of the cyst are well delineatedwalls of the cyst are well delineated . . • •echolucentecholucent . . • •sharply defined posterior bordersharply defined posterior border . . • •uniocular ,if multiocular the septa areuniocular ,if multiocular the septa are thin wallsthin walls . .
• •no significant internal echono significant internal echo . .
Normal ovaryNormal ovary
N. Gaafian follicle corpus luteum cystN. Gaafian follicle corpus luteum cyst
OHSS PCOOHSS PCO
Multilocular simple ov. cyst Unilocular simple ov. CystMultilocular simple ov. cyst Unilocular simple ov. Cyst
Dermoid cystDermoid cyst
) )mature cystic teratomamature cystic teratoma ( (
b) b) malignantmalignant > • > •55 cmcm. .
• •bilateral in the majoritybilateral in the majority . . • •multilocularmultilocular . . • •echoicechoic . . • •thick wallsthick walls . . • •thick incomplete septathick incomplete septa . . • •may, intracystic papillary projectionsmay, intracystic papillary projections . . • •may ,fluid in cul de sacmay ,fluid in cul de sac . .
ExamplesExamples : : * *Serous cystadenocarcinomaSerous cystadenocarcinoma . . * *Mucinous cystadenocarcinomaMucinous cystadenocarcinoma . . * *Endometriod carcinomaEndometriod carcinoma . .
malignant ovarian cystmalignant ovarian cyst with intracystic papillary projectionswith intracystic papillary projections
22 . .SolidSolid Predominent solid ovarian mass in thePredominent solid ovarian mass in the
adnexal areaadnexal area . .a) a) benignbenign
• •usually , bilateralusually , bilateral . . • •well defined outlineswell defined outlines . . • •hypoechoichypoechoic . .
ExamplesExamples : : * *Brenner ′ s tumorsBrenner ′ s tumors . . * *teratomasteratomas . . * *fibromafibroma . .
Solid ovarian tumorSolid ovarian tumor
b) b) malignantmalignant • •usually , bilateralusually , bilateral . . • •hypoechoichypoechoic . . • •with ,ascitiswith ,ascitis . .
ExamplesExamples : :
* *Clear cell carcinomaClear cell carcinoma . .
* *Krukenberg ′s tumoursKrukenberg ′s tumours . .
* *FibrosarcomaFibrosarcoma . . * *Undifferentiated carcinomaUndifferentiated carcinoma . .
malignant ovarian tumormalignant ovarian tumor
Key messageKey message Simple ov. Cyst malignant ov. CystSimple ov. Cyst malignant ov. Cyst
Adnexal MassesAdnexal Masses
predominent mass in the adnexal areapredominent mass in the adnexal area . .
ExamplesExamples : :
* *Tubal ectopic pregnancyTubal ectopic pregnancy . . * *hydrosalpenixhydrosalpenix . . * *hematosalpenixhematosalpenix . . * *Pyosalpenix or tuboovarian abscessPyosalpenix or tuboovarian abscess..
Ectopic PregnancyEctopic Pregnancy
hydrosalpnixhydrosalpnix
))22 ( (Evaluation of the Uterine CavityEvaluation of the Uterine Cavity
a) a) Echogenic Foci within the Uterine CavityEchogenic Foci within the Uterine Cavity..As: IUCDAs: IUCD . .
b) b) Endometrial Fluid CollectionEndometrial Fluid Collection . .As: bleedingAs: bleeding . .
a) Echogenic Foci within the Uterine Cavitya) Echogenic Foci within the Uterine Cavity
asas : :
* *IUCDIUCD . . * *retained products of conception (bones)retained products of conception (bones) . . * *Intrauterine adhesionsIntrauterine adhesions . .
IUCD in situIUCD in situ
Intrauterine adhesionsIntrauterine adhesions
b) Endometrial Fluid Collectionb) Endometrial Fluid Collection
11 . .PhysiologicalPhysiological * *At the time of menstruationAt the time of menstruation . . * *Early gestational sacEarly gestational sac . .22 . .Complicated pregnancyComplicated pregnancy * *Blighted ovumBlighted ovum . . * *Pseudo gestational sac of ectopic pregPseudo gestational sac of ectopic preg . . * *Missed abortionMissed abortion . . * *Incomplete abortionIncomplete abortion . .33 . .infectioninfection * *Endometritis , PID ( exudate )Endometritis , PID ( exudate ) . . * *Pyometria ( pus )Pyometria ( pus ) . .44 . .abn. uterine bleedingabn. uterine bleeding * *DUBDUB . .
normal & abnormal GSnormal & abnormal GS
Abnormal GSAbnormal GS
Blighted ovumBlighted ovum
Pseudo gestational sac empty GSPseudo gestational sac empty GS
Key pointsKey points 11 . .TV sonography with or without salineTV sonography with or without saline
instillation is a primary investigation ininstillation is a primary investigation in diagnosis of uterine pathology in womendiagnosis of uterine pathology in women
with with abnormal uterine bleedingabnormal uterine bleeding . .22..TV/S is useful in evaluation of TV/S is useful in evaluation of ovarianovarian
massesmasses combined with color Doppler combined with color Doppler . .33 . .Vaginal US is a gold standard forVaginal US is a gold standard for
diagnosis of diagnosis of PCOPCO.. 44 . .TV/S has a crucial role in monitoring ofTV/S has a crucial role in monitoring of
ovulation ( ovulation ( folliculometryfolliculometry) in infertility) in infertility . . 55 . .TV sonography is helpful in evaluationTV sonography is helpful in evaluation
of of early pregnancy complicationsearly pregnancy complications . .
Thank youThank you
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