Table Of Content

Page iii Practical Gynaecological Ultrasound Edited by Jane Bates DCR DMU MPhil Ultrasound Department St James's University Hospital, Leeds, UK Page iv © 1997 GREENWICH MEDICAL MEDIA LTD 219 The Linen Hall 162-168 Regent Street London W1R 5TB ISBN 1 900151 510 First Published 1997 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of JA Bates to be identified as editor of this work has been asserted by her in accordance with the Copyright, Designs and Patents Acts 1988. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Distributed worldwide by Oxford University Press Designed and Produced by Derek Virtue, DataNet Printed in Hong Kong by Dah Hua Page v Contents Contributors xiii Preface xv Chapter 1 1 Principles of Equipment Selection Tony Evans Introduction 3 Spatial Resolution 3 Axial Resolution 4 Lateral Resolution 5 Slice Thickness 6 Temporal Resolution 6 Penetration 7 Contrast Resolution 8 Probe Shape and Size 8 Transabdominal Imaging 8 Transvaginal Imaging 10 Scanning Ergonomics 10 Operating Modes 10 CW Doppler 11 Pulsed Doppler 11 Colour Flow Doppler 11 Power Doppler 12 Safety 12 Ultrasonic Safety 13 Electrical Safety 13 Microbiological Safety 14 Mechanical Safety 14 Page vi Chapter 2 17 Practical Equipment Operation and Technique Jane Bates Practical Approach to Image Optimisation 17 Choice of Approach 17 Transabdominal Scanning (TA) 17 Preparation 17 Transabdominal Technique 18 Image Orientation 19 Transvaginal Scanning (TV) 21 Acceptability to the Patient 21 Transvaginal Technique 21 Image Orientation 24 Doppler Techniques 24 Additional Techniques 26 Image Recording 27 The Role of the Sonographer 27 Chapter 3 31 Anatomy, Physiology and Ultrasound Appearances Rosemary Lee, Jane Bates Introduction 33 Vagina 33 33 Uterus 33 Uterine Anomalies 35 Ovaries 36 Fallopian Tubes 38 Peritoneum and Ligaments 39 Vasculature 40 Musculature 42 Bladder and Ureters 42 Anatomical Changes Related to Age 44 Physiology of Reproduction 44 Haemodynamics of the Uterus and Ovaries and the Use of Doppler Ultrasound 48 Page vii Doppler of Uterine Arteries 48 Doppler of Ovarian Arteries 49 Chapter 4 55 Pathology of the Uterus, Cervix and Vagina Heather Andrews Introduction 57 The Uterus 57 Fibroids (Leiomyomata) 57 Malignant Change 63 Uterine Sarcoma 63 Other Uterine Tumours 63 Endometrial Disease 63 The Post-Menopausal Uterus 64 Endometrial Hyperplasia 64 Endometrial Polyp 65 Medications 66 Oral Contraceptive Pill 66 Hormone Replacement Therapy (HRT) 66 Tamoxifen 66 Endometrial Carcinoma 67 Adenomyosis 71 Adenomyosis 71 Endometritis 71 Uterine Surgery 72 Hysterectomy 72 Transcervical Resection of the Endometrium (TCRE) 72 Caesarean Section 72 Asherman's Syndrome 73 Intrauterine Contraceptive Device 74 The Cervix 76 Benign Conditions 76 Nabothian Cysts 76 Cervical Fibroid 76 Cervical Polyp 77 Cervical Carcinoma 77 Page viii Cervical Stenosis 79 The Vagina 80 Vaginal Fluid Collections 80 Haematocolpos 80 Gartner's Duct Cyst 82 Vaginal Tumours 82 Chapter 5 85 Pathology of Ovaries, Tubes and Adnexae, and Non-Gynaecological Pelvic Pathology Louise Gaunt Introduction 87 Clinical Presentation 87 Clinical Presentations of Ovarian Disease 87 Examination Technique 87 Benign Physiological Cysts 88 Follicular Cysts 88 Corpus Luteal Cysts 88 Benign Ovarian Lesions of Mixed Echogenicity 89 Mucinous Cystadenoma 89 Serous Cystadenoma 90 Ovarian Teratoma/Dermoid 91 Benign Solid Ovarian Tumours 92

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