婦產(chǎn)科疾病的超聲診斷ENGLISH

UltrasonographyonGynecologyandObstetricsLiuLipingSangreal--------uterusTHEDAWINCICODEPelvicCavityPosterior:Occupiedbyrectum,colon,andileumAnterior:bladder,ureters,ovaries,fallopiantubes,uterus,andvaginaNORMALANATOMYPre-inspection:Moderatebladderfilling

UterusHollow,pear-shapedorganDividedintofundus,body,andcervixUsuallyanteflexedandantevertedCoveredwithperitoneumexceptanteriorlybelowtheoswhereperitoneumisreflectedontobladderSupportedbylevatoranimusclesandpelvicfasciaRoundligamentkeepsuterusinpositionUterinesizePrepubertal:3cmlongby0.5to1.0cmwideMenarcheal:8cmlongby4cmwidePostmenopausal:3.5to5.5cmlongby1to2cmwideNormalsize:2~3(thick)×4~5(width)×7~8cm(length)Uterinelongitudinaldiameter

Uterinewidediameter

UterusbeforeandaftertheTrail

length7~8cmbeforeandaftertheTrail

2~3cmwidth4~5cmUterinePositionMidlineanteversion:mostcommon;degreeofanteversionisbladderdistentiondependentRightorleft:normalvariantinabsenceofpelvicmassesRetroverted:entireorgandisplacedposteriorlyRetroflexed:bodydisplacedwithrespecttocervixUltrasonographyofnormaluterusUterineserosalayer:Linearhigh-echo;clear,smooth;

Myometrium:Homogeneousmiddle-echo;Endometria:Themiddlelineofhighecho,aroundtheweakecho.Itiswellknownthattheendometriumchangesdynamicallyinresponsetocyclichormonalflux.UterineserosalayerMyometriumEndometriaNormaluterustransabdominalultrasonographyTransvaginalsagittalviewoftheuterus.Theroundedfundusisshowntowardtheleftoftheimagewiththeendometrialstriperummingthroughthemiddleoftheuterinecavity.MyometriumEndometriaUterineserosalayerFallopianTube（輸卵管）Infundibulum:funnel-shapedlateraltubethatprojectsbeyondthebroadligamenttooverlietheovariesAmpulla:sidestpartofthetubewherefertilizationoccursIsthmus:hardestpart;liesjustlateraltotheuterusLength:12cm;suppliedbyovarionarteriesandveinsOvary（卵巢）AlmondshapedAttachedtobackofthebroadligamentbymesovarium;sometimescalledsuspensoryligamentoftheovaryLiesinovarianfossaFossaisboundedbyexternaliliacvessels,ureter,andobturatornerveReceivesbloodfromovarianarteryBlooddrainedbyovarianveinintoinferiorvenacavaonright;onleftbyovarianveinintolertrenalveinSonographyofthenormalovaryAnovoidhomogeneousechodensity;follicularcystsareoftenpresent.Thebestsonographicmarkerfortheovaryisidentificationofafollicularcyst,whichhastheclassicappearanceofbeingthinwalledandanechoicwiththrough-transmissionposteriorly.TransabdominalsagittalimageshowstheleftovaryposteriortotheurinarybladderTransvaginalsagittalimageoftheovaryovarianfollicleFollicularwallflowCommonDiseasesofObstetricsandGynecologyGynecology：Leiomyoma；Carcinoma;；；OvarianTumors;Inflammatorymass;etc.Obstetrics：Naturalpregnancy；Abnormalpregnancy;etc.TheuterusLeiomyoma/HysteromyomaCharacteristicsofLeiomyomasMostcommonpelvictumorSmoothmusclecellcompositionFibrosisoccursafteratrophicofdegenerativechangesDegenerationoccurswhenfibroidsoutstriptheirbloodsupply;calcificationMaybepedunculatedClinical:enlargeduterus,profuseandprolongedbleeding,painUterineLocationsofleiomyomasSubmucosalErodeintoendomertialcavity–heavybleeding;infertilityIntramuralMayenlargetocausepressureonadjacentorgans;infertilitySubserosalMayenlargetocausepressureonadjacentorgansSubserousmyomaBroadligamentmyomaCervicalmyomaintramurousmyomaSubmucousmyomaUltrasonicperformanceTwo-dimensional：①IncreaseduterinebodyorFormdisorders；②②Sphericalhypoechoicareaintheuterinebody，Rearechoattenuation；③WithcalcificationorCysticchange,etc；；④Signsofoppression；ColorDoppler：Tumoraroundwiththebloodflowsignalintheshapeofringorsemi-circularring；Dopplerspectrum：：Mediumresistanceindex，RI0.6±0.1。intramurousmyomaSubserousmyomaintramurousmyomaSubserousmyomaCervicalmyomaAbundanttumorbloodflowMUTRI0.61SubmucousmyomawithcalcificationTeratomaDermoidTummors（卵巢良性性囊性畸胎胎瘤/皮樣樣囊腫)Pathology：derivesfromgermcell，themostcommonovarianneoplasm,constituting20%ofovariantumors.upto20%arebilateral.About80%occurinwomenofchildbearingage.Sizerangesfromsmallto40cmUnliateral,roundtoovalmassContainsfaty,sebaceousmaterial,hair,cartilage,bone,teethClinical:asymptomatictoabdominalpain,enlargementandpressure;pedunculated,subjecttotorsionSonography:Cystic/complex/solidmass,echogeniccomponents;acousticshadowingSpecialUltrasoundFindings:1.Acysticmass:withanechogenicmuralnodule2.Apastesign：particulateliptinite3.Afluffofhairsign4.Afat-fluidlevelsign：withfluidlevelinthecyst,fatabove,fluidbelow.5.AcomplexmasscysticteratomaofovaryAcysticmassPastesignFluffofhairsignPastesignFat-fluidlevelsignAcomplexmassA8yearsoldgirl,cuttingoffathreekilogramsbenignteratomaTheroleofUltrasoundinObstetricsTRIMESTERSFirsttrimester=0to12weeksofgestationSecondtrimester=13to26weeksofgestationThirdtrimester=27to42weeksofgetsationPosttermpregnancy=>42weeksofgestationIndicationsforFirst-TrimesterSonographyConfirmpresenceofintrauterinepregnancyEvaluateforsuspectedectopicpregnancyDefinecauseofvaginalbleedingDeterminegestationalageConfirmsuspectedmultiplegestationsAidininvasiveproceduresEvaluatepelvicmassesDetectuterineabnormalitiesNaturalpregnancyNonagepregnancy(First-Trimester)Definition：Pregnancybefore12weekend.5weekspregnant—Gestationalsac；6-7weekspregnant—Germ;7-8Weeks—Primitivehearttubepulse；8-11weeks—Yolksac;9weeks——Embryonic,placenta.TheNormalFirstTrimesterSonographicFeaturesofaNormalGestationalSacShape:roundofovalPosition:fundalormiddleportionofuterus;acenterpositionrelativetoendometriumContour:smoothWall:echogenic;3mmofmoreinthicknessInternallandmarks:yalksacpresentwhengestationalsacislargerthan10mm;embryopresentwhengestationalsacislargerthan18mmGrowth:1mmperday(range:0.7mmto1.5mmperday)4-5weekspregnantInthegestationalsacwecanseeaembryopoint,theearliestembryo.7weekspregnantFetuswasabout4mm，，wecanseeapparentheartthrob,andsmalllimbbud.8weekspregnantThree-dimensionalultrasoundshowitsbeginningoftheshapeofahuman.UmbilicalbordEmbryonicheadEmbryonicabdomenYolksacEmbronicheadAmnioticsac9weekspregnantKnownasafetal，，Developmentofthevariouspartsofthefetus,tendstoimprove.12weekspregnantThespineisidentifiable,asthetwobead-likehighecho.Ears,limbs,bonescanbeshownandmeasurement.UltrasoundoftheSecondandThirdTrimestersIndicationsforSecond-andThird-TrimesterEstimategestationalageforpatientswithuncertaindatesEvaluateuterinesizeandclinicaldatediscrepanciesEvaluatefetalgrowthEstimatefetalweightDeterminefetalpresentationEvaluatefetallifeprovideadjuncttoamniocentesis,percutaneousumbilicalbloodsamplingprocedure,orcerclageplacementEvaluateuterineabnormalityEvaluateabnoumalmaternalserumalpha-fetoproteinvaluesEvaluateabnormalamnioticfluidEvaluateplacentaEtc.TheSecond-andThird-Trimester(Metaphaseandterminalprengancy)Mid-pregnancy:13-27weekspregnancy.Late-pregnancy:Morethan28weeksofpregnancy.ScanningTechniquesSurveyuterusObservecardiacactivityDeterminepositionandnumberofthefetusandplacentaAssessamnioticfluidLookforuterineofplacentalmassesandfetalanomaliesCheckcontents1、Fetalhead：：BPDbiparietaldiameter;2、Fetalabdomen:ACabdomencircumference;3、Fetallimb：：FLfemurlength;4、Others：：Placenta,Fetalheartrate,Amnioticfluid,etc.1、FetalheadMeasuringtheBiparietalDiameter(BPD)Obitainbiparietaldiameterofthefetalheadatthetransverselevelofthemidbrain:falx,cavumseptipellucidi,andthalamicnucleiMakesuretheheadissymmetricandovalMeasurefromoutertoinnermarginsoftheskullInthethirdtrimester,theBPDisnotasaccurateinpredictingfetalageFetalhead,after12weekendpregnantFetalsideprofile,wecanobserveitsforehead,nose,lip,andchin,etc.2、FetalabdomenThehepatobiliarysystem:liver,portvenoussysterm,hepaticveinsandarteries,gallbladder,andbileductsThegastrointestinalsystem:theesophagus,stomach,smallandlargeintestines(colon)Theurinarysystem:kidneys,adrenalglands,ureters,bladder.Thefetalabdomencircumference（AC)isthemostwidelymeasuredMeasuringtheAbdominalCircumference(AC)TheACshouldbetakenfromaroundtransverseimagewiththeumbilicalportionoftheleftportalveinmidlinewithintheliverTheoutermarginoftheabdominalwallshouldbemeasuredTheabdominalwallmeasurementistheleastaccurateThefetallivergallbladderstomachportvenousspinegallbladderstomach3、FetallimbsTheupperlimbs:theulnatheradiusthehumerusThelowerlimbs:thefemur/thethighbonethefibulathetibiaThefemuristhemostwidelymeasuredlongbone（FLfemurlength）FemurmeasurementHyperechoniclinearstructurerepresentstheossifiedportionofthefemoualdiaphysisandcorrespondstofemorallengthmeasurementfromthegreatertrochantertothefemoralcondylesThemormalfemurhasastraightlaeralborderandacurvedmedialborderFemurlengthmaybeusedwiththesameaccuracyasBPDtopredictgestationalageFemurlengthmayindicateskeletaldysplasiasorintrauterinegrowthrestrictionLongsectionoftheupperlimbsTheradiusTheulnaThehumerusFemur/thighboneFibula/peroneTibia/shinboneLongsectionofthelowerlimbs4、Theplacenta（（胎盤）Themajorfoleoftheplacentaistopermittheexchangeofoxygenatedmaternalblood(richinoxgenandnutrients)withdeoxygenatedfetalblood.Thethicknessoftheplacentavarieswithgestationalage,withaminimumdiameterof15mminfetusesgreaterthan23weeks.Thesizeoftheplacentararelyexceeds50mminthenormalfetus.Anteriorplacentaat21weeksofgastationTheplacentaUmbilicalbordAmnioticfluidThefetalposteriorplacentaat29weeksofgestationcalcificationAnteriorplacentaat39weeksofgastationCalmlittlefaceEatingtoeEatingfingersCryingPouttingFetalwithumbilicalcordaroundtheneckFetalwithcleftlipsmailingBaobao,Beibei100daysold!Baobao,Beibei1year'sbirthday!THANKSALL!9、靜夜四無鄰鄰，荒居舊業(yè)業(yè)貧。。12月-2212月-22Friday,December23,202210、雨中黃葉葉樹，燈下下白頭人。。。23:30:3823:30:3823:3012/23/202211:30:38PM11、以我獨(dú)沈沈久，愧君君相見頻。。。12月-2223:30:3823:30Dec-2223-Dec-2212、故故人人江江海海別別，，幾幾度度隔隔山山川川。。。。23:30:3823:30:3823:30Friday,December23,202213、乍乍見見翻翻疑疑夢夢，，相相悲悲各各問問年年。。。。12月月-2212月月-2223:30:3823:30:38December23,202214、他鄉(xiāng)鄉(xiāng)生白白發(fā)，，舊國國見青青山。。。23十十二二月202211:30:38下下午午23:30:3812月月-2215、比不不了得得就不不比，，得不不到的的就不不要。。。。。十二月月2211:30下下午12月月-2223:30December23,202216、行動動出成成果，，工作作出財(cái)財(cái)富。。。2022/12/2323:30:3823:30:3823December202217、做前前，能能夠環(huán)環(huán)視四四周；；做時(shí)時(shí)，你你只能能或者者最好好沿著著以腳腳為起起點(diǎn)的的射線線向前前。。。11:30:38下下午午11:30下下午23:30:3812月月-229、沒有失失敗，只只有暫時(shí)時(shí)停止成成功！。。12月-2212月-22Friday,December23,202210、很多事事情努力力了未必必有結(jié)果果，但是是不努力力卻什么么改變也也沒有。。。23:30:3823:30:3823:3012/23/202211:30:38PM11、成功就就是日復(fù)復(fù)一日那那一點(diǎn)點(diǎn)點(diǎn)小小努努力的積積累。。。12月-2223:30:3823:30Dec-2223-Dec-2212、世間成成事，不不求其絕絕對圓滿滿，留一一份不足足，可得得無限完完美。。。23:30:3823:30:3823:30Friday,December23,202213、不知香積積寺，數(shù)里里入云峰。。。12月-2212月-2223:30:3823:30:38December23,202214、意意志志堅(jiān)堅(jiān)強(qiáng)強(qiáng)的的人人能能把把世世界界放放在在手手中中像像泥泥塊塊一一樣樣任任意意揉揉捏捏。。23十十二二月月202211:30:38