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1、UltrasonographyUltrasonography on on Gynecology and ObstetricsGynecology and ObstetricsLiu LipingSangreal-uterusTHE DATHE DAWINCI CODEWINCI CODEPelvic CavitylPosterior : Occupied by rectum, colon, and ileumlAnterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vaginaNORMAL ANATOMYPre-ins
2、pection :Moderate bladder filling UteruslHollow, pear-shaped organlDivided into fundus, body, and cervixlUsually anteflexed and antevertedlCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderlSupported by levator ani muscles and pelvic fascialRound ligame
3、nt keeps uterus in positionUterine sizelPrepubertal : 3 cm long by 0.5 to 1.0 cm widelMenarcheal: 8 cm long by 4 cm widelPostmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wideNormal size : 23(thick)45(width)78 cm(length)Uterine longitudinal diameter Uterine wide diameter Uterus before and after the Tr
4、ail length 78cmbefore and after theTrail 23cmwidth 45cmUterine PositionlMidline anteversion: most common; degree of anteversion is bladder distention dependentlRight or left: normal variant in absence of pelvic masseslRetroverted: entire organ displaced posteriorlylRetroflexed: body displaced with r
5、espect to cervixUltrasonography of normal uteruslUterine serosa layer: Linear high-echo ;clear, smooth;l Myometrium: Homogeneous middle-echo ;lEndometria: The middle line of high echo , around the weak echo . It is well known that the endometrium changes dynamically in response to cyclic hormonal fl
6、ux.Uterine serosa layer Myometrium Endometria Normal uterusNormal uterus transabdominal ultrasonographytransabdominal ultrasonographyTransvaginal sagittal view of the uterus. The Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the rounded fundus is shown towa
7、rd the left of the image with the endometrial stripe rumming through image with the endometrial stripe rumming through the middle of the uterine cavity.the middle of the uterine cavity.MyometriumEndometriaUterine serosa layerFallopian Tube（输卵管）lInfundibulum: funnel-shaped lateral tube that projects
8、beyond the broad ligament to overlie the ovarieslAmpulla: sidest part of the tube where fertilization occurslIsthmus: hardest part; lies just lateral to the uteruslLength: 12 cm; supplied by ovarion arteries and veinsOvary（卵 巢）l Almond shapedlAttached to back of the broad ligament by mesovarium; som
9、etimes called suspensory ligament of the ovarylLies in ovarian fossalFossa is bounded by external iliac vessels, ureter, and obturator nervelReceives blood from ovarian arterylBlood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal veinSonography of th
10、e normal ovarylAn ovoid homogeneous echodensity; follicular cysts are often present.lThe best sonographic marker for the ovary is identification of a follicular cyst, which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.Transabdominal sagittal imag
11、e shows the Transabdominal sagittal image shows the left ovary posterior to the urinary bladderleft ovary posterior to the urinary bladderTransvaginal sagittal image of the ovaryTransvaginal sagittal image of the ovaryovarian follicleFollicular wall flowFollicular wall flowCommon Diseases of Obstetr
12、ics and GynecologyGynecology ：Leiomyoma ；Carcinoma ;； Ovarian Tumors; Inflammatory mass ;etc. Obstetrics：Natural pregnancy ；Abnormal pregnancy; etc.The uterus Leiomyoma /HysteromyomaCharacteristics of LeiomyomaslMost common pelvic tumorlSmooth muscle cell compositionlFibrosis occurs after atrophic o
13、f degenerative changeslDegeneration occurs when fibroids outstrip their blood supply; calcificationlMay be pedunculatedlClinical: enlarged uterus, profuse and prolonged bleeding, painUterine Locations of leiomyomasSubmucosal Erode into endomertial cavity heavy bleeding; infertility Intramural May en
14、large to cause pressure on adjacent organs; infertility Subserosal May enlarge to cause pressure on adjacent organs Subserous myomaBroad ligament myomaCervical myomaintramurous myomaSubmucousmyomaUltrasonic performancelTwo-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic ar
15、ea in the uterine body ，Rear echo attenuation； With calcification or Cystic change, etc；Signs of oppression；lColor Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ；lDoppler spectrum：Medium resistance index，RI 0.60.1。intramurous myomaSubserous myomaintramuro
16、us myomaSubserous myomaCervical myomaAbundant tumor blood flowAbundant tumor blood flowMUTUTRI 0.61RI 0.61Submucousmyoma with calcificationTeratoma Dermoid Tummors （卵巢良性囊性畸胎瘤/皮样囊肿)lPathology ：derives from germ cell， the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to 20% are bilateral. About 80% occur in women of childbearing age. lSize ranges from small to 40 cmlUnliateral,round to ov
