ultrasound

Dr. Assma’a

5th stage

The principal imaging technique in gynaecology is Ultrasound it can be performed in clinic as part of gynaecological examination .
Transabdominal US. Need distended bladder acting as a window to the pelvic organ.
Transvaginal scan high frequency probe because of its proximity to the pelvic organ it provide superior images , the bladder should be empty.

The technique employs high frequency(3-7.5)mHz low intensity pulsed sound waves

The array of elements at the tip triggered in sequence, reflected signals from the surface are displayed as 2 dimentional echo.
Normal pelvic appearance on US
Uterus on US:
Uterine muscle appears as uniform grainy texture around a central endometrial strip.
Uterus can be measured as dimension.
The endometrium is initially thin less than 3 mm in diameters then three layers in the mid cycle the in the luteal phase become thick and white ( secretory phase )


Normal fallopian tubes can’t be seen by US as distinct from the surrounding bowel. the fimbrial end can be seen if there is free fluid in the pouch of douglas.
Ovaries
are identified as lozenge shaped structure lateral to the uterus usually related to the internal iliac veins . early in the cycle several follicles of about 5 mm in diameters can be identified but after day 8 a dominant follicle can be seen in one of the ovaries and it’s growth can be tracked
Prior to ovulation the follicular diameters is about 20 mm in diameters after rupture it become an irregular solid cystic mass , the corpus luteum

Pathological appearances

Fibroid are easily identified as discrete circular structure a rising in the myometrium.

The position (subserous,intramural,submucos,cervical) and the size of fibroid can be Documented.

Endometrial polyps will cause local thickening of the endometrium.this will be enhanced by instillation of normal saline by means of catheter (salinehystero salpingography)
Adenomyosis cause diffuse thickening of the myometrium with spots of hyper and hypoechogenisity.
Endometrial polyp will cause local thickening of the endometrium sometime normal saline instilled through the cervix will visualise if the thick endometrium is due polyp or thickening

Done By : Omar. M. Sh _Albeshrei