Ultrasound in Gynecology: An Atlas and Guide PDF
Preview Ultrasound in Gynecology: An Atlas and Guide
Mala Sibal Ultrasound in Gynecology An Atlas and Guide 123 Ultrasound in Gynecology Mala Sibal Ultrasound in Gynecology An Atlas and Guide Mala Sibal Department of Fetal Medicine and Obstetric & Gynecological Ultrasound Manipal Hospital Bangalore Karnataka India ISBN 978-981-10-2713-0 ISBN 978-981-10-2714-7 (eBook) DOI 10.1007/978-981-10-2714-7 Library of Congress Control Number: 2017930417 © Springer Nature Singapore Pte Ltd. 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifcally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microflms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifc statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Nature Singapore Pte Ltd. The registered company address is 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore This book is dedicated to my patients, in whose service I learnt medicine, and to my husband, Abbas Shad, for his unstinting love and support. Foreword by Suresh Seshadri It is indeed a pleasure to pen a few words about this book, which is a felt need in the feld of gynecological ultrasound. This book is the culmination of decades of the author’s experience and a strong commitment to share the knowledge to the fraternity. The chapters have been well thought out and give several practice points which can be easily adapted to improve qual- ity of imaging and reporting. The initial chapters of the book describe not only the basic techniques in imaging but also advanced techniques like 3D and other innovative methods like gel sonovaginography. Each chapter has been structured in a simple, comprehendible fashion. The fow of information has been well thought out which not only makes for easy reading but also for easy recall. The illustrations are of high quality from the author’s own body of work. The summary boxes at the end of each chapter give the key points in a nutshell, which are a ‘must know’. When any book is written, the one important question that comes to the mind is ‘who is this book meant for?’ I remember asking the author the same question when she embarked on this journey. Her answer was ‘to everyone who wants to know about gynecological ultrasound!’ I’m very happy to note that this book has fulflled her desire as it is written in a way that will be useful for students, clinicians and imaging specialists alike. This indeed is one of the best books written on the subject with an international appeal and a ‘must possess’ for any practitioner. Mediscan Systems Suresh Seshadri Chennai, India 07.07.2016 vii Foreword by Lil Valentin It is a great privilege for me to have been given the possibility to read this book on gynecologi- cal ultrasound written by Mala Sibal. It is a book that fulfls the needs of those practicing gynecological ultrasound and wanting to improve their skills, as well as the needs of those planning to practice gynecological ultrasound and wishing to learn how to do it and how to interpret the images. This book is full of tips and tricks that help improve visualisation of both simple and com- plex structures. It presents clinically important facts about each type of pathology, and facts are presented in a concise and structured manner – the structure being the same in all chapters. No information is redundant. The structured and concise format makes this book very easy to read and to digest. Last, but not least, there are hundreds of beautiful and instructive ultrasound images illustrating the typical ultrasound features of each type of pathology. Images are essen- tial, because one image tells us more than 1000 words. Lund University Lil Valentin Lund, Sweden 02.10.2016 ix Preface In recent years, gynecological ultrasound has seen rapid advances in new investigative tech- niques, primarily owing to improved ultrasound technology, imaging equipment and expand- ing research in the feld. There is a need to provide a practical guide and comprehensive atlas that covers new-found knowledge and novel diagnostic techniques to update and supplement the limited literature that is currently available. The literature in this feld is limited partly because gynecological ultrasound has historically been in the shadow of obstetric and fetal ultrasound. There is often a lack of focused effort to follow-up on gynecological cases to vali- date diagnoses through either surgery or histopathology, due to which defnitive developments have not been rapid enough and quality literature relatively sparse. Further, since a typical medical residency provides precious little exposure in the use of ultrasound to diagnose gyne- cological pathologies, it is not uncommon for clinicians and radiologists to lack an in-depth knowledge of gynecological ultrasound. This book is intended to fll these gaps. It is a comprehensive atlas and guidebook which is accompanied by abundant illustrations of classical and new ultrasound features and gyneco- logical pathologies. The text and images contained in this book are primarily based on my work as an instructor, researcher and practitioner, having personally performed detailed scans and thorough investigations in numerous complex gynecological cases over my career, some of which have resulted in novel biomarkers for early detection of pathologies which I have reported in research journals and have included in this book. This atlas and guide has been written to cater to practicing sonologists, gynaecologists and radiologists and those who are training to become practitioners in these felds, as well as post- graduate medical students in these felds. It will be useful not only for the routine diagnosis of gynecological pathologies but also in cases of emergencies like ovarian torsion, where a delay in diagnosis can cause infarction and loss of the ovaries, or where a wrong diagnosis can lead to unnecessary surgery with added risks and cost. It will also help practitioners differentiate between multiple conditions that are often lumped together as a single diagnosis, like the com- monly used ambiguous term ‘complex adnexal cyst’, which provides no information on whether the cyst may be physiological, malignant or benign. Specifcity is the key to an effec- tive diagnosis, determination of specialists who need to be consulted, surgeries that may need to be performed and, more generally, proper disease management. This is particularly relevant in today’s world where medical litigations are on the rise. A frustrating challenge in gynecological ultrasound has been the lack of a global consen- sus in the use and meaning of terminologies employed in the feld. Of late, the International xi xii Preface Endometrial Tumor Analysis (IETA), Morphological Uterus Sonographic Assessment (MUSA) and International Ovarian Tumour Analysis (IOTA) groups have arrived at a consen- sus to describe various sonographic features and gynecological pathologies. I am a primary researcher of the ongoing IOTA study, and this book uses and provides an explanation of these terminologies, thereby encouraging the reader to use standard terms for evaluation and reporting. This book has been organised into chapters, based on the origin of pathologies in various gynecological organs and structures of the female pelvis, with a summary of key points in each chapter for quick reference. The chapters include drawings and a rich set of comprehensive single and composite images to illustrate key concepts and pinpoint various features and pathol- ogies. In addition to basic greyscale images of two-dimensional scans, there are also relevant images of Doppler and three-dimensional ultrasound scans. I sincerely hope the reader uses this book as an essential guide, lucid atlas and a reliable reference for accurate diagnosis and research of gynecological pathologies, and in turn helps further this important and fascinating feld. Bangalore, India Mala Sibal Acknowledgements The compiling of knowledge, examination of cases and follow-up over the years that led to this book have been due to the support and help of many colleagues, friends and family members. The frst among them is Dr. Priti Venkatesh who is my senior, friend, mentor and the head of our department at Manipal Hospital. It was by observing her scans that I developed an enduring fascination for the feld of gynecological ultrasound. I shall remain indebted to her for the sup- port she provided me, especially during my initial years, when literature in this feld was sparse. I am also grateful to Dr. Jaya Bhat, the head of the Obstetrics and Gynecology Department when I frst began, who encouraged me to focus on ultrasound and supported my work. In addition I would like to acknowledge the support I have received from my colleague Dr. Thankam Rathinaswami for her critical review of my research and academic work over the years. I would also like to thank Manipal Hospital, a large multi-speciality hospital in Bangalore, where I have the opportunity to investigate a variety of cases and also gain access to informa- tion from follow-up visits of patients, which has helped my learning process tremendously. I would like to thank my referring clinicians who keep me posted and provide an excellent feedback and follow-up of cases evaluated using ultrasound. I would like to especially thank Dr. Gayathri Karthik who has supported my professional endeavours with great interest. I also thank the pathologists of our hospital with whom I interact on the pathology of com- plex cases. A special thanks to Dr. Mahesha Vankalakunti who helped with the pathological correlation of the ‘follicular ring sign’, a new ultrasound feature for early diagnosis of ovarian torsion, which is included in this book. I would like to thank the staff and nurses of our department as well, who support not only my clinical work but also help with the follow-up of cases. I also thank the postgraduates of the Obstetrics and Gynecology Department at Manipal Hospital who assisted me through the process of writing this book. These include Dr. Supriya Preman, Dr. Bharti Singh, Dr. Vasumathi Pasupaleti and Dr. Spurthi Janney. A special word of thanks goes out to Padmini Baruah, a bright young law school graduate, who played a signifcant role in helping me write and proofread various parts of this book. I am also thankful to Shibani Timothy and Nomita Singh for helping me with the fnal proof-reading of this book. I would also like to specially thank Dr. Rajesh Uppal, a distinguished radiologist, who criti- cally evaluated and proofread the chapters. I also thank Dr. Suresh Seshadri for encouraging me to write this book and for authoring the fore- word. I would also like to thank Springer for their effort and support in the publication of this book. Finally, I would like to thank my family. A special thanks to my parents Pushpa Sibal and Anil Sibal, for their support and for the interest in science that they inculcated in their children. I also wish to thank my aunt Shashi Sibal, an amazing teacher, who taught me biology and got me interested in pursuing medicine. A big thanks to my brother, Dr. Sandeep Sibal, for step- ping in at various points to help solve challenges I faced during the writing of this book. Lastly, I would like to thank my children Sohail Shad and Sonia Shad for completing my life, helping me structure chapters and encouraging me to write this book. xiii
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