1. Is Ultrasonography helpful Gynecologic Diagnosis ? Azza Al-Yamaniin
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. vaginal oocyte collection.
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
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 .

9. 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
including IUCD localization.
(3) Early pregnancy complications
including ectopic pregnancy.

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

12. N. Secretory N. proliferative
endometrium endometrium

13. Submucous fibroid

14. anterior wall fibroid

15. pedunculated subserous fibroid

16. Broad ligament fibroid

17. Interamural fibroid

18. Calcified fibroid

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

20. endometrial polyp

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

22. Adenomyosis

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

24. Pyometria endometrial carcinoma

25. Key message
Fibroid
Endometrial polyp
Uterine mass
Adenomiosis
Endometrial carcinoma

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

27. Normal ovary

28. N. Gaafian follicle corpus luteum cyst

29. OHSS PCO

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

31. Dermoid cyst
( mature cystic teratoma)

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

33. malignant ovarian cyst
with intracystic papillary projections

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

35. Solid ovarian tumor

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

37. malignant ovarian tumor

38. Key message
Simple ov. Cyst malignant ov. Cyst

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

40. Ectopic Pregnancy

41. hydrosalpnix

43. (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 as:
* 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
Abnormal GS

49. Blighted ovum

50. Pseudo gestational sac empty GS

51. 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