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Is Ultrasonography helpful in

Is Ultrasonography helpful in Gynecologic Diagnosis ? Azza Al-Yamani Prof. of Obstetrics and Gynecology. The objectives of this slide show are : * Know the principles of Ulrtasuond imaging.

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Is Ultrasonography helpful in

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  1. Is Ultrasonographyhelpful 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 assistin performinginvasive 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 .

  8. 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.

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

  10. (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).

  11. N. Secretory N. proliferative endometrium endometrium

  12. Submucous fibroid

  13. anterior wall fibroid

  14. pedunculated subserous fibroid

  15. Broad ligament fibroid

  16. Interamural fibroid

  17. Calcified fibroid

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

  19. endometrial polyp

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

  21. 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.

  22. Pyometria endometrial carcinoma

  23. 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 .

  24. Normal ovary

  25. N. Gaafian follicle corpus luteum cyst

  26. OHSS PCO

  27. Multilocular simple ov. cyst Unilocular simple ov. Cyst

  28. Dermoid cyst ( mature cystic teratoma)

  29. b) malignant • > 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.

  30. malignant ovarian cyst with intracystic papillary projections

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

  32. Solid ovarian tumor

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

  34. malignant ovarian tumor

  35. Key message Simple ov. Cyst malignant ov. Cyst

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

  37. Ectopic Pregnancy

  38. hydrosalpnix

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

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

  41. IUCD in situ

  42. Intrauterine adhesions

  43. 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.

  44. normal & abnormal GS Abnormal GS

  45. Blighted ovum

  46. Pseudo gestational sac empty GS

  47. 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.

  48. Thank you

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