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Is Ultrasonography helpful in Gynecologic Diagnosis ? Azza Al-Yamani Prof. of Obstetrics and Gynecology.

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Presentation on theme: "Is Ultrasonography helpful in Gynecologic Diagnosis ? Azza Al-Yamani Prof. of Obstetrics and Gynecology."— Presentation transcript:

1 Is Ultrasonography helpful in Gynecologic Diagnosis ? Azza Al-Yamani Prof. of Obstetrics and Gynecology

2 The objectives of this slide show are : * Know the principles of Ulrtasuond imaging. * Be familial with the US normal appearance of different pelvic structures. * Be able to interpret US images in common gynecologic pathology. * Be able to differentiate between US appearance of benign and malignant pelvic masses. * Know the advantages of TV/ US over abdominal transducers in Gyn.

3 US imaging is a simple and noninvasive procedure that has the advantage of avoiding radiation hazards. It is especially helpful in patients in whom pelvic exam. is difficult as children,virgins & incooperative.

4 Doppler sonography Can measure the velocity profile of blood flowing through pelvic bl. vessels to differentiate benign from malignant adnexal masses. Finally TV/US can be used to assist in performing invasive gynecological procedures as vaginal oocyte collection.

5 Transvaginal ultrasound (TV/US) has the advantage over the abdominal US in gynecology, because the close proximity of the intravaginal trancducer allows for high – frequency scanning and better resolution of the pelvic organs. However, every TV/US examination should be preceded by transabdominal imaging.

6 Technology Intermittent high – frequency sound waves are generated by applying an alternating electric current to a transducer made of a piezoelectric material. The transducer is connected to the abdominal wall by placing a water –soluble gel on the skin to diminish the loss of US waves at the interface between the transducer and the skin.

7 The transducer emits a pulse of sound waves The transducer emits a pulse of sound waves that passes through structures of different tissue densities, some of the energy proportional to the difference in densities is reflected or echoed back to the transducer. This in turn,stimulates the transducer to generate a small electrical voltage that is then amplified and displayed on a screen.

8

9 Clinical Applications Clinical Applications in gynecology The use of ultrasonography in the diagnosis of gynecological lesions can be summarized in 3 indications : (1) Pelvic mass differentiation * Uterine masses. * Ovarian masses. cystic or solid * Adnexal masses. cystic or solid.

10 (2) evaluation of the uterine cavity (2) evaluation of the uterine cavity including IUCD localization. (3) Early pregnancy complications including ectopic pregnancy.

11 (1) Pelvic Masses Uterine masses 1. Leiomyoma ( fibroid ) more in the midline position. more in the midline position. contiguous with the uterus. contiguous with the uterus. well defined. well defined. homogeneous,hypoechoic mass. homogeneous,hypoechoic mass. may have small cysts ( degeneration), may have small cysts ( degeneration), or calcified areas (calcification).

12 N. Secretory N. proliferative endometrium endometrium

13 Submucous fibroid

14 anterior wall fibroid anterior wall fibroid

15 pedunculated subserous fibroid pedunculated subserous fibroid

16 Broad ligament fibroid

17 Interamural fibroid

18 Calcified fibroid

19 2. endometrial polyp 2. endometrial polyp discrete mass (es) within the uterine cavity. discrete mass (es) within the uterine cavity. enlargement of the uterus. prominent endometrial echo complex with prominent endometrial echo complex with saline contrast.

20 endometrial polyp endometrial polyp

21 3. Adenomyosis 3. Adenomyosis uterine enlargement. uterine enlargement. normal central endometrial echo. normal central endometrial echo. honey comb appearance. honey comb appearance.

22 Adenomyosis

23 4. endometrial carcinoma very important that it may not alter the very important that it may not alter the uterine echo pattern. prominent endometrial echo complex prominent endometrial echo complex > 4mm in postmenopausal woman. loss of the normal endometrial / myometrial loss of the normal endometrial / myometrialjunction. pyometria, or hematometria. pyometria, or hematometria.

24 Pyometria endometrial carcinoma

25 Fibroid Endometrial polyp Adenomiosis Endometrial carcinoma Uterine mass Key message

26 Ovarian masses 1.Cystic cystic mass free in the adenexal area not related to the uterus. a) Benign < 5cm ( cystic ovary ) physiological. < 5cm ( cystic ovary ) physiological. walls of the cyst are well delineated. walls of the cyst are well delineated. echolucent. echolucent. sharply defined posterior border. sharply defined posterior border. uniocular,if multiocular the septa are uniocular,if multiocular the septa are thin walls. thin walls. no significant internal echo. no significant internal echo.

27 Normal ovary

28 N. Gaafian follicle corpus luteum cyst

29 OHSS PCO OHSS PCO

30 Multilocular simple ov. cyst Unilocular simple ov. Cyst Multilocular simple ov. cyst Unilocular simple ov. Cyst

31 Dermoid cyst ( mature cystic teratoma)

32 b) malignant b) malignant > 5 cm. > 5 cm. bilateral in the majority. bilateral in the majority. multilocular. multilocular. echoic. echoic. thick walls. thick walls. thick incomplete septa. thick incomplete septa. may, intracystic papillary projections. may, intracystic papillary projections. may,fluid in cul de sac. may,fluid in cul de sac.Examples: * Serous cystadenocarcinoma. * Mucinous cystadenocarcinoma. * Endometriod carcinoma.

33 malignant ovarian cyst malignant ovarian cyst with intracystic papillary projections

34 2. Solid 2. Solid Predominent solid ovarian mass in the adnexal area. a) benign usually, bilateral. usually, bilateral. well defined outlines. well defined outlines. hypoechoic. hypoechoic.Examples: * Brenner s tumors. * teratomas. * fibroma.

35 Solid ovarian tumor

36 b) malignant b) malignant usually, bilateral. usually, bilateral. hypoechoic. hypoechoic. with,ascitis. with,ascitis.Examples: * Clear cell carcinoma. * Krukenberg s tumours. * Fibrosarcoma. * Undifferentiated carcinoma.

37 malignant ovarian tumor malignant ovarian tumor

38 Key message Simple ov. Cyst malignant ov. Cyst

39 Adnexal Masses Adnexal Masses predominent mass in the adnexal area. predominent mass in the adnexal area.Examples: * Tubal ectopic pregnancy. * hydrosalpenix. * hematosalpenix. * Pyosalpenix or tuboovarian abscess.

40 Ectopic Pregnancy Ectopic Pregnancy

41 hydrosalpnix hydrosalpnix

42

43 (2) Evaluation of the Uterine Cavity (2) Evaluation of the Uterine Cavity a) Echogenic Foci within the Uterine Cavity. As: IUCD. b) Endometrial Fluid Collection. As: bleeding.

44 a) Echogenic Foci within the Uterine Cavity a) Echogenic Foci within the Uterine Cavityas: * IUCD. * retained products of conception (bones). * Intrauterine adhesions.

45 IUCD in situ

46 Intrauterine adhesions

47 b) Endometrial Fluid Collection 1. Physiological * At the time of menstruation. * Early gestational sac. 2. Complicated pregnancy * Blighted ovum. * Pseudo gestational sac of ectopic preg. * Missed abortion. * Incomplete abortion. 3. infection * Endometritis, PID ( exudate ). * Pyometria ( pus ). 4. abn. uterine bleeding * DUB.

48 normal & abnormal GS normal & abnormal GS Abnormal GS

49 Blighted ovum

50 Pseudo gestational sac empty GS

51 Key points Key points 1. TV sonography with or without saline instillation is a primary investigation in diagnosis of uterine pathology in women with abnormal uterine bleeding. 2.TV/S is useful in evaluation of ovarian masses combined with color Doppler. 3. Vaginal US is a gold standard for diagnosis of PCO. 4. TV/S has a crucial role in monitoring of ovulation ( folliculometry) in infertility. 5. TV sonography is helpful in evaluation of early pregnancy complications.

52 Thank you


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