Ultrasonic diagnostic method. Interpretation of the results of ultrasound examination (ultrasound) of the pelvic organs

Abdominal ultrasound decoding is a series of numbers and characteristics of reflected ultrasound that you can see in the protocol of your own study.

In order to understand them at least a little before you go to the doctor, we suggest reading the following information.

What will the decoding of the ultrasound of the abdominal cavity show

First, let's see what this ultrasound shows.

Behind the front wall of the abdomen is a large space - the abdominal cavity. It contains quite a few organs, which will be shown by ultrasound of the abdominal cavity. This:

• stomach
• intestines
• pancreas
• liver
• bile ducts: intra- and extrahepatic
• spleen
• gallbladder
• kidneys
• adrenal glands
• abdominal aorta and its branches
• lymph nodes
• lymph trunks and vessels
• department of the autonomic nervous system
• nerve plexuses.

The abdominal cavity is lined with two layers of a thin membrane - the peritoneum. Its inflammation is called peritonitis and is a life-threatening condition. The organs are differently covered by the peritoneum: some are wrapped in it, some do not even touch, but are inside the boundaries outlined by it. Conventionally, the cavity is divided into the abdominal cavity proper and the retroperitoneal space. The latter is at the bottom of the list of organs, starting with the kidneys.

All these organs - both the abdominal cavity and the space behind the peritoneum - are looked at by an ultrasound examination of the abdominal cavity. This study is able to detect the presence of structural damage, inflammation, pathological formations, an increase or decrease in an organ, and a violation of its blood supply. Ultrasound does not see how a sick or healthy organ copes with its functional duties.

What does an ultrasound. The study helps to find the cause of the disease in such cases:

• pain or discomfort in the abdomen
• bitterness in the mouth
• feeling of a full stomach
• fatty food intolerance
• increased gas production
• frequent bouts of hiccups
• feeling of heaviness in the right or left hypochondrium
• jaundice
• high blood pressure
• lower back pain
• fever not due to a cold
• non-diet weight loss
• belly enlargement
• as a control over the effectiveness of the treatment of pathologies of the digestive system
• and also as a routine examination, including with existing anomalies in the development of organs, cholelithiasis.

Pathology determined by ultrasound

What does abdominal ultrasound diagnose? With the help of this study, the following diseases can be detected:

1. From the side of the gallbladder:

• acute and chronic cholecystitis
• bladder empyema
• gallstone pathology
• during a choleretic breakfast, it is possible to assess the motor function of the bladder
• developmental anomalies (kinks, partitions).

2. From the side of the liver:

• cirrhosis
• hepatitis
• abscesses
• tumors, including metastases
• hepatosis
• "Stagnation" in the liver due to cardiopulmonary diseases
• fatty change in the liver.

3. From the side of the kidneys and urinary system:

• kidney tumors
• "shrunken kidney"
• pyelonephritis
• narrowing of the ureters
• stones and "sand" in the kidneys.

4. From the side of the spleen, ultrasound of the abdominal cavity reveals:

5. From the side of the pancreas:

• cysts
• tumors
• abscesses
• stones in the channels
• signs of acute and chronic pancreatitis.

6. Ultrasound reveals free fluid in the abdomen

7. From the side of the abdominal part of the aorta or its branches, an aneurysm and its dissection, vasoconstriction can be seen

8. From the side of the retroperitoneal lymph nodes, their increase is visible, the uniformity of the structure

How to understand the results of the study

To do this, consider the form (protocol) of ultrasound. It indicates the points that relate to each organ separately.

Liver

Deciphering the ultrasound of the abdominal cavity in relation to this organ includes:

Share sizes:

Deciphering the results

1. Fatty hepatosis is evidenced by an increase in the echo density of the organ in the form of small foci. The edge of the liver is rounded. In the last stages, due to the compaction of the organ, it is impossible to see the portal vessels.
2. With cirrhosis of the liver, its increase, dilation of the portal and splenic veins is visible. The lower edge of the organ will also be rounded, the contours will be uneven. The increase in echo density in this case will be large-focal. Free fluid in the abdominal cavity (ascites) is also determined.
3. If an increase in size, rounding of the edges, as well as an expansion of the vena cava and the absence of narrowing it on inspiration, is described, this indicates congestion in the liver due to a heart or lung disease.
4. If foci are described in which there is a violation of the normal echostructure, this may indicate malignant or benign tumors, cysts or abscesses.

In the video, the specialist talks about the errors that occur during ultrasound examination of the abdominal organs.

gallbladder

The norm of ultrasound according to the results of the examination of this organ:

• Shape: various - pear-shaped, cylindrical.
• Dimensions: width 3-5 cm, length 6-10 cm.
• Volume: 30-70 cu. cm.
• Walls: up to 4 mm thick.
• Education in the lumen: in the norm they are absent.
• Acoustic shadow from formations: this applies to stones and bladder tumors. By the presence of this shadow, the types of stones are deciphered (they come in different compositions).
• Whether they move or not: the stones are usually mobile, but can be soldered to the wall or be large. According to this and some other signs, one can judge whether the formation is a tumor.

Signs of pathology of the gallbladder

1. In acute cholecystitis, there is a thickening of the wall of the organ, while the dimensions can be normal, reduced or enlarged. The wall can also be described as a "double circuit", and the presence of fluid around the bladder indicates that local peritonitis has already developed and an urgent operation is needed.
2. Thickening of the wall will be in chronic cholecystitis. The contour in this case is clear and dense.
3. In conclusion, various deformations of the organ can be described. This is not a disease, but a structural feature.
4. If echo-negative objects are described that leave an acoustic shadow, while the bladder wall is thickened and the contour is uneven, we are talking about calculous cholecystitis. At the same time, the expansion of the bile ducts indicates that the stone blocks the exit of bile.

Deciphering ultrasound of the bile ducts

Normally, on ultrasound, the bile ducts have the following characteristics:

• common bile duct: 6-8 mm in diameter
• intrahepatic ducts: should not be dilated

Norms of the pancreas on ultrasound

• There shouldn't be any extras.
• head: up to 35 mm
• body: up to 25 mm
• tail: about 30mm
• contour: smooth
• echostructure: homogeneous
• echogenicity: neither decreased nor increased
• Wirsung duct: 1.5-2 mm
• education: normally they are not.

A decrease in the echo density of the gland indicates acute pancreatitis, an increase in it indicates chronic pancreatitis or cancer. The expansion of the Wirsung duct also speaks of chronic inflammation. The "favor" of cancer is evidenced by a segmental increase in size and uneven contour of the gland, depression on the surface of the liver, as well as displacement or compression of the inferior vena cava or aorta.

Deciphering ultrasound of the spleen

• dimensions: length - up to 11 cm, thickness - up to 5 cm, longitudinal section - up to 40 square meters. cm
• splenic index: no more than 20 cm 2
• structure: normal - homogeneous
• splenic vein at the hilum.

1. You can see an increase in the size of the organ. It is associated both with certain blood diseases and with liver diseases (for example, cirrhosis) or infectious diseases.
2. Compacted (less often - less dense) tissue indicates a spleen infarction, that is, that as a result of thrombosis or injury, the death of some part of the organ occurred.
3. Ultrasound also allows you to see the rupture of the spleen, which usually occurs either with a strong injury, or with a minor bruise, but in the case of an enlarged organ.

Read also:

When should pregnant women go for an abdominal ultrasound?

Ultrasound of hollow organs (stomach, small, large and rectum)

It only indicates whether there is a symptom of an “affected organ” (it should not be) and whether there is fluid deposition in the intestinal lumen (this should also not be).

If ultrasound was also performed on the kidneys, then a description of this organ is also included in the conclusion of the study. The results of the examination of the kidneys by ultrasound are normal:

• width: 5-6cm
• length - about 11 cm
• organ thickness: 4-5cm
• kidney parenchyma - no more than 23 mm thick
• pelvis should not be dilated
• there should not be any structures in the lumen of the pelvis and ureters.

Lymphatic structures on ultrasound imaging

Ultrasound of retroperitoneal lymph nodes normally suggests such a conclusion "Lymph nodes are not visualized." That is, if they are of normal size, their ultrasound "does not see".

An increase in these organs of immunity indicates either an infectious disease present in the abdominal cavity, or a malignant formation. In the latter case, they can increase due to the fact that cancer cells of the hematopoietic system "live" in them, as well as with metastases of any adjacent organ tumor.

Sonologist's conclusions

In the conclusion of the ultrasound, the sonologist (ultrasound diagnostics doctor) indicates the presence of a pathology: he describes what the echo signs look like.

If the doctor indicates in the direction that it is necessary to conduct an examination for some disease, but his ultrasound did not visualize (for example, calculous cholecystitis), then the phrase “Echo signs of the disease were not detected” may be. The final diagnosis is made only by the doctor who directs the examination.

Who needs to undergo dopplerometry of the celiac vessels

This examination, which is also called UZDG (that is, Doppler ultrasound) of the celiac vessels, is often performed together with an ultrasound. The patient does not feel differentiated and is not more harmful than ultrasound. It allows you to evaluate the anatomy and characteristics of blood circulation in such vessels as:

• abdominal aorta
• common hepatic artery
• iliac arteries
• celiac trunk
• splenic artery
• superior mesenteric artery
• hepatic portal vein and its branches
• inferior vena cava.

Ultrasound of the abdominal vessels allows timely detection of early disorders in the vessels, identification and assessment of the degree of increase in pressure in the portal vein (with cirrhosis, “stagnant” liver), and assessment of the result of cava filter implantation.

Ultrasound of the abdominal aorta and its branches helps in the diagnosis of:

• fainting
• frequent headaches
• epileptic seizures
• high blood pressure
• repeated strokes (sometimes blood clots can “fly off” from this large vessel)
• pain in the legs
• potency disorders
• aortic aneurysms
• atherosclerotic lesion
• vasoconstriction
• anomalies in the development of large vessels.

duplex scanning

The study of blood vessels during ultrasound on modern equipment almost always includes duplex angioscanning. This is the "gold standard" in the assessment of blood circulation in the venous vessels.

It allows you to identify pathological blood reflux, obstruction of blood flow, to assess their localization, extent and severity.

With this type of study, the sonologist receives a two-dimensional color image of the celiac vessels, where red means the movement of blood to the sensor, and blue - on the contrary, from the sensor. According to the intensity of red and blue colors, the doctor draws conclusions about the speed of blood flow in any part of the vascular system.

An ultrasound diagnostic method is a method of obtaining a medical image based on the registration and computer analysis of ultrasonic waves reflected from biological structures, i.e., based on the echo effect. The method is often called echography. Modern devices for ultrasound examination (ultrasound) are universal high-resolution digital systems with the ability to scan in all modes (Fig. 3.1).

Ultrasound of diagnostic power is practically harmless. Ultrasound has no contraindications, it is safe, painless, atraumatic and not burdensome. If necessary, it can be carried out without any preparation of patients. Ultrasound equipment can be delivered to any functional unit for examination of non-transportable patients. A great advantage, especially with an unclear clinical picture, is the possibility of a simultaneous study of many organs. Also important is the high cost-effectiveness of echography: the cost of ultrasound is several times less than X-ray studies, and even more so computed tomography and magnetic resonance.

However, the ultrasonic method also has some disadvantages:

High apparatus and operator dependence;

Greater subjectivity in the interpretation of echographic images;

Low information content and poor demonstrativeness of frozen images.

Ultrasound has now become one of the methods most commonly used in clinical practice. In the recognition of diseases of many organs, ultrasound can be considered as the preferred, first and main diagnostic method. In diagnostically difficult cases, ultrasound data makes it possible to outline a plan for further examination of patients using the most effective radiation methods.

PHYSICAL AND BIOPHYSICAL FOUNDATIONS OF ULTRASONIC DIAGNOSIS

Ultrasound is called sound vibrations that lie above the threshold of perception by the human hearing organ, that is, having a frequency of more than 20 kHz. The physical basis of ultrasound is the piezoelectric effect discovered in 1881 by the Curie brothers. Its practical application is associated with the development by the Russian scientist S. Ya. Sokolov of ultrasonic industrial flaw detection (late 20s - early 30s of the XX century). The first attempts to use the ultrasound method for diagnostic purposes in medicine date back to the end of the 30s. XX century. The widespread use of ultrasound in clinical practice began in the 1960s.

The essence of the piezoelectric effect lies in the fact that during the deformation of single crystals of certain chemical compounds (quartz, titanium-barium, cadmium sulfide, etc.), in particular, under the influence of ultrasonic waves, electrical charges of opposite sign arise on the surfaces of these crystals. This is the so-called direct piezoelectric effect (piezo in Greek means to press). On the contrary, when an alternating electric charge is applied to these single crystals, mechanical vibrations arise in them with the emission of ultrasonic waves. Thus, the same piezoelectric element can alternately be either a receiver or a source of ultrasonic waves. This part in ultrasonic devices is called an acoustic transducer, transducer or sensor.

Ultrasound propagates in media in the form of alternating zones of compression and rarefaction of molecules of a substance, which perform oscillatory motions. Sound waves, including ultrasonic ones, are characterized by an oscillation period - the time during which a molecule (particle) makes one complete oscillation; frequency - the number of oscillations per unit time; length - the distance between the points of one phase and the propagation velocity, which depends mainly on the elasticity and density of the medium. The wavelength is inversely proportional to its frequency. The shorter the wavelength, the higher the resolution of the ultrasonic device. In medical ultrasound diagnostic systems, frequencies from 2 to 10 MHz are commonly used. The resolution of modern ultrasonic devices reaches 1-3 mm.

Any medium, including various tissues of the body, prevents the propagation of ultrasound, i.e., it has different acoustic resistance, the value of which depends on their density and the speed of ultrasound. The higher these parameters, the greater the acoustic impedance. Such a general characteristic of any elastic medium is denoted by the term "impedance".

Having reached the boundary of two media with different acoustic resistance, the beam of ultrasonic waves undergoes significant changes: one part of it continues to propagate in the new medium, being absorbed by it to some extent, the other is reflected. The reflection coefficient depends on the difference in the acoustic impedance values ​​of adjacent tissues: the greater this difference, the greater the reflection and, of course, the greater the amplitude of the recorded signal, which means the lighter and brighter it will look on the screen of the device. A complete reflector is the boundary between tissues and air.

ULTRASOUND TECHNIQUES

Currently, ultrasound in B- and M-mode and Doppler sonography are used in clinical practice.

B-mode is a technique that provides information in the form of two-dimensional gray-scale tomographic images of anatomical structures in real time, which makes it possible to assess their morphological state. This mode is the main one; in all cases, ultrasound begins with its use.

Modern ultrasonic equipment captures the smallest differences in the levels of reflected echoes, which are displayed in many shades of gray. This makes it possible to distinguish between anatomical structures, even slightly differing from each other in terms of acoustic impedance. The lower the echo intensity, the darker the image, and, conversely, the greater the energy of the reflected signal, the brighter the image.

Biological structures can be anechoic, hypoechoic, medium echogenic, hyperechoic (Fig. 3.2). An anechoic image (black) is characteristic of formations filled with liquid, which practically does not reflect ultrasonic waves; hypoechoic (dark gray) - tissues with significant hydrophilicity. An echopositive image (gray) shows most tissue structures. Dense biological tissues have increased echogenicity (light gray). If the ultrasonic waves are completely reflected, then the objects look hyperechoic (bright white), and behind them there is a so-called acoustic shadow, which looks like a dark track (see Fig. 3.3).

a B C D E

Rice. 3.2. Scale of levels of echogenicity of biological structures: a - anechoic; b - hypoechoic; c - medium echogenicity (echo-positive); d - increased echogenicity; e - hyperechoic

Rice. 3.3. Echograms of the kidneys in longitudinal section with the designation of structures of various

echogenicity: a - anechoic dilated pelvicalyceal complex; b - hypoechoic kidney parenchyma; c - liver parenchyma of medium echogenicity (echo-positive); d - renal sinus of increased echogenicity; e - hyperechoic calculus in the ureteropelvic segment

The real-time mode provides a "live" image of organs and anatomical structures in their natural functional state on the monitor screen. This is achieved by the fact that modern ultrasonic devices provide many images following one after another with an interval of hundredths of a second, which in total creates a constantly changing picture that captures the slightest changes. Strictly speaking, this technique and the ultrasound method in general should not be called "echography", but "echoscopy".

M-mode - one-dimensional. In it, one of the two spatial coordinates is replaced by a temporal one, so that the distance from the sensor to the located structure is plotted along the vertical axis, and time is plotted along the horizontal axis. This mode is mainly used for examining the heart. It provides information in the form of curves reflecting the amplitude and speed of movement of cardiac structures (see Fig. 3.4).

dopplerography is a technique based on the use of the physical Doppler effect (named after an Austrian physicist). The essence of this effect is that ultrasonic waves are reflected from moving objects with a changed frequency. This frequency shift is proportional to the speed of movement of the located structures, and if their movement is directed towards the sensor, the frequency of the reflected signal increases, and, conversely, the frequency of the waves reflected from the receding object decreases. We encounter this effect constantly, observing, for example, a change in the frequency of sound from passing cars, trains, and planes.

Currently, in clinical practice, flow spectral Dopplerography, color Doppler mapping, power Doppler, convergent color Doppler, three-dimensional color Doppler mapping, and three-dimensional power Doppler imaging are used to varying degrees.

Stream spectral dopplerography designed to assess blood flow in relatively large

Rice. 3.4. M - modal curve of movement of the anterior leaflet of the mitral valve

vessels and chambers of the heart. The main type of diagnostic information is a spectrographic record, which is a sweep of the blood flow velocity over time. On such a graph, speed is plotted along the vertical axis, and time is plotted along the horizontal axis. Signals displayed above the horizontal axis come from the blood flow directed to the sensor, below this axis - from the sensor. In addition to the speed and direction of blood flow, the type of the Doppler spectrogram can also determine the nature of the blood flow: laminar flow is displayed as a narrow curve with clear contours, turbulent flow is displayed as a wide non-uniform curve (Fig. 3.5).

There are two options for streaming Doppler: continuous (constant wave) and pulsed.

Continuous Doppler ultrasound is based on constant emission and constant reception of reflected ultrasonic waves. In this case, the magnitude of the frequency shift of the reflected signal is determined by the movement of all structures along the entire path of the ultrasonic beam within the depth of its penetration. The information received is thus cumulative. The impossibility of isolated analysis of flows in a strictly defined place is a disadvantage of continuous Doppler sonography. At the same time, it also has an important advantage: it allows the measurement of high blood flow rates.

Pulse Dopplerography is based on the periodic emission of series of pulses of ultrasonic waves, which, reflected from erythrocytes, consistently perceive -

Rice. 3.5. Doppler spectrogram of the transmitral blood flow

with the same sensor. In this mode, signals reflected only from a certain distance from the sensor, which is set at the discretion of the doctor, are recorded. The location of the blood flow study is called the control volume (CV). The ability to assess blood flow at any given point is the main advantage of pulsed Doppler sonography.

color doppler mapping is based on encoding in color the value of the Doppler shift of the emitted frequency. The technique provides direct visualization of blood flow in the heart and in relatively large vessels (see Fig. 3.6 on the color insert). Red color corresponds to the flow going towards the sensor, blue - from the sensor. Dark shades of these colors correspond to low speeds, light shades - high. This technique allows assessing both the morphological state of the vessels and the state of the blood flow. The limitation of the technique is the impossibility of obtaining an image of small blood vessels with a low blood flow velocity.

Power Doppler is based on the analysis of not frequency Doppler shifts, which reflect the speed of erythrocytes, as in conventional Doppler mapping, but the amplitudes of all Doppler spectrum echoes, which reflect the density of erythrocytes in a given volume. The resulting image is similar to conventional color Doppler mapping, but differs in that all vessels are imaged regardless of their path relative to the ultrasound beam, including blood vessels with very small diameters and low blood flow rates. However, according to power Dopplerograms it is impossible to judge either the direction, or the nature, or the speed of blood flow. Information is limited only by the fact of blood flow and the number of vessels. Shades of color (as a rule, with a transition from dark orange to light orange and yellow) carry information not about the speed of blood flow, but about the intensity of echo signals reflected by moving blood elements (see Fig. 3.7 on the color insert). The diagnostic value of power dopplerography lies in the possibility of assessing the vascularization of organs and pathological areas.

The possibilities of color Doppler mapping and power Doppler are combined in a technique convergent color dopplerography.

The combination of B-mode with streaming or power color mapping is referred to as the duplex study, which provides the most information.

3D Doppler and 3D Power Doppler are techniques that allow us to observe three-dimensional picture spatial arrangement of blood vessels in real time in any angle, which allows to assess with high accuracy their relationship with various anatomical structures and pathological processes, including malignant tumors.

echocontrasting. This technique is based on the intravenous administration of special contrast agents containing free gas microbubbles. To achieve clinically effective contrast enhancement, the following prerequisites are necessary. With intravenous administration of such echocontrast agents, only those substances that freely pass through the capillaries of the pulmonary circulation can enter the arterial bed, i.e., gas bubbles should be less than 5 microns. The second prerequisite is the stability of gas microbubbles during their circulation in the general vascular system for at least 5 minutes.

In clinical practice, the echocontrasting technique is used in two directions. The first is dynamic echocontrast angiography. This significantly improves the visualization of blood flow, especially in small deep-seated vessels with a low blood flow rate; the sensitivity of color Doppler mapping and power Dopplerography is significantly increased; the possibility of observing all phases of vascular contrasting in real time is provided; increases the accuracy of assessing stenotic lesions of blood vessels. The second direction is tissue echocontrasting. It is ensured by the fact that some echocontrast substances are selectively included in the structure of certain organs. At the same time, the degree, speed and time of their accumulation in unchanged and in pathological tissues are different. Thus, in general, it becomes possible to assess organ perfusion, improve the contrast resolution between normal and diseased tissue, which contributes to an increase in the accuracy of diagnosing various diseases, especially malignant tumors.

The diagnostic capabilities of the ultrasound method have also expanded due to the emergence of new technologies for obtaining and post-processing processing of echographic images. These include, in particular, multifrequency sensors, widescreen, panoramic, three-dimensional imaging technologies. Promising directions for further development of the ultrasonic diagnostic method are the use of matrix technology for collecting and analyzing information about the structure of biological structures; the creation of ultrasonic devices that give images of full sections of the anatomical regions; spectral and phase analysis of reflected ultrasonic waves.

CLINICAL APPLICATION OF ULTRASONIC DIAGNOSIS

Ultrasound is currently used in many areas:

Planned studies;

Urgent diagnostics;

Monitoring;

Intraoperative diagnostics;

Postoperative studies;

Monitoring the implementation of diagnostic and therapeutic instrumental manipulations (punctures, biopsies, drainage, etc.);

Screening.

Urgent ultrasound should be considered the first and mandatory method of instrumental examination of patients with acute surgical diseases of the abdomen and pelvis. At the same time, the accuracy of diagnosis reaches 80%, the accuracy of recognition of damage to parenchymal organs is 92%, and the detection of fluid in the abdominal cavity (including hemoperitoneum) is 97%.

Monitoring ultrasounds are performed repeatedly at different intervals during an acute pathological process to assess its dynamics, the effectiveness of the therapy, and early diagnosis of complications.

The goals of intraoperative studies are to clarify the nature and prevalence of the pathological process, as well as control over the adequacy and radicalness of the surgical intervention.

Ultrasound in the early stages after surgery is mainly aimed at establishing the cause of the unfavorable course of the postoperative period.

Ultrasonic control over the performance of instrumental diagnostic and therapeutic manipulations ensures high accuracy of penetration to certain anatomical structures or pathological areas, which significantly increases the effectiveness of these procedures.

Screening ultrasounds, i.e. studies without medical indications, are carried out for the early detection of diseases that are not yet clinically manifested. The expediency of these studies is evidenced, in particular, by the fact that the frequency of newly diagnosed diseases of the abdominal organs during screening ultrasound of “healthy” people reaches 10%. Excellent results in the early diagnosis of malignant tumors are provided by screening ultrasound of the mammary glands in women over 40 years of age and of the prostate in men over 50 years of age.

Ultrasound can be performed by both external and intracorporeal scanning.

External scanning (from the surface of the human body) is the most accessible and not at all burdensome. There are no contraindications to its implementation, there is only one general limitation - the presence of a wound surface in the scanning area. To improve the contact of the sensor with the skin, its free movement along the skin and to ensure the best penetration of ultrasonic waves into the body, the skin at the examination site should be generously lubricated with a special gel. Scanning of objects located at different depths should be carried out with a certain frequency of radiation. So, when examining superficially located organs (thyroid gland, mammary glands, soft tissue structures of the joints, testicles, etc.), a frequency of 7.5 MHz and higher is preferable. To study deeply located organs, sensors with a frequency of 3.5 MHz are used.

Intracorporeal ultrasound is carried out by introducing special sensors into the human body through natural openings (transrectal, transvaginal, transesophageal, transurethral), puncture into vessels, through surgical wounds, and also endoscopically. The sensor is brought as close as possible to a particular organ. In this regard, it is possible to use high-frequency transducers, which sharply increases the resolution of the method, and it becomes possible to visualize the smallest structures that are inaccessible with external scanning. For example, transrectal ultrasound compared with external scanning provides important additional diagnostic information in 75% of cases. The detection of intracardiac thrombi in transesophageal echocardiography is 2 times higher than in external examination.

The general patterns of the formation of an echographic gray-scale image are manifested by specific patterns characteristic of a particular organ, anatomical structure, and pathological process. At the same time, their shape, size and position, the nature of the contours (smooth / uneven, clear / fuzzy), internal echostructure, displacement, and for hollow organs (gall and urinary bladders), in addition, the state of the wall (thickness, echo density, elasticity ), the presence of pathological inclusions in the cavity, primarily stones; degree of physiological contraction.

Cysts filled with serous fluid are displayed as rounded homogeneously anechoic (black) zones surrounded by an echopositive (gray) capsule rim with even, clear contours. A specific echographic sign of cysts is the effect of dorsal enhancement: the posterior wall of the cyst and the tissues behind it look lighter than the rest of the length (Fig. 3.8).

Cavernous formations with pathological contents (abscesses, tuberculous cavities) differ from cysts in uneven contours and, most importantly, inhomogeneity of the echo-negative internal echostructure.

Inflammatory infiltrates are characterized by an irregular rounded shape, fuzzy contours, uniformly and moderately reduced echogenicity of the pathological process zone.

The echographic picture of the hematoma of the parenchymal organs depends on the time elapsed since the injury. In the first few days, it is homogeneous echo-negative. Then echopositive inclusions appear in it, which are a reflection of blood clots, the number of which is constantly growing. After 7-8 days, the reverse process begins - the lysis of blood clots. The content of the hematoma again becomes uniformly echo-negative.

The echostructure of malignant tumors is heterogeneous, with zones of the entire spectrum

Rice. 3.8. Sonographic image of a solitary kidney cyst

echogenicity: anechoic (hemorrhages), hypoechoic (necrosis), echopositive (tumor tissue), hyperechoic (calcifications).

The echographic picture of the stones is very demonstrative: a hyperechoic (bright white) structure with an acoustic echo-negative dark shadow behind it (Fig. 3.9).

Rice. 3.9. Sonographic image of gallbladder stones

Currently, ultrasound is available in almost all anatomical regions, organs and anatomical structures of a person, however, to a different extent. This method is a priority in assessing both the morphological and functional state of the heart. It is also highly informative in the diagnosis of focal diseases and injuries of the parenchymal organs of the abdomen, diseases of the gallbladder, pelvic organs, external male genital organs, thyroid and mammary glands, eyes.

INDICATIONS FOR USING

Head

1. Examination of the brain in young children, mainly with suspicion of a congenital disorder of its development.

2. Examination of cerebral vessels in order to establish the causes of cerebrovascular accident and to evaluate the effectiveness of operations performed on the vessels.

3. Examination of the eyes for the diagnosis of various diseases and injuries (tumors, retinal detachment, intraocular hemorrhages, foreign bodies).

4. Examination of the salivary glands to assess their morphological state.

5. Intraoperative control of the totality of removal of brain tumors.

Neck

1. Examination of the carotid and vertebral arteries:

Prolonged, often recurring severe headaches;

Frequent fainting spells;

Clinical signs of cerebral circulation disorders;

Clinical subclavian steal syndrome (stenosis or occlusion of the brachiocephalic trunk and subclavian artery);

Mechanical trauma (damage to blood vessels, hematomas).

2. Examination of the thyroid gland:

Any suspicion of her illness;

3. Examination of lymph nodes:

Suspicion of their metastatic lesion with a detected malignant tumor of any organ;

Lymphomas of any localization.

4. Inorganic neoplasms of the neck (tumors, cysts).

Breast

1. Heart examination:

Diagnosis of congenital heart defects;

Diagnosis of acquired heart defects;

Quantitative assessment of the functional state of the heart (global and regional systolic contractility, diastolic filling);

Assessment of the morphological state and function of intracardiac structures;

Identification and determination of the degree of violations of intracardiac hemodynamics (pathological shunting of blood, regurgitant flows in case of insufficiency of heart valves);

Diagnosis of hypertrophic myocardiopathy;

Diagnosis of intracardiac thrombi and tumors;

Identification of ischemic myocardial disease;

Determination of fluid in the pericardial cavity;

Quantification of pulmonary arterial hypertension;

Diagnosis of heart damage in case of mechanical trauma of the chest (bruises, ruptures of the walls, partitions, chords, valves);

Evaluation of the radicalness and effectiveness of heart surgery.

2. Examination of the respiratory and mediastinal organs:

Determination of fluid in the pleural cavities;

Clarification of the nature of lesions of the chest wall and pleura;

Differentiation of tissue and cystic neoplasms of the mediastinum;

Assessment of the state of mediastinal lymph nodes;

Diagnosis of thromboembolism of the trunk and main branches of the pulmonary artery.

3. Examination of the mammary glands:

Clarification of uncertain radiological data;

Differentiation of cysts and tissue formations detected by palpation or x-ray mammography;

Evaluation of seals in the mammary gland of unclear etiology;

Assessment of the state of the mammary glands with an increase in axillary, sub- and supraclavicular lymph nodes;

Assessment of the state of silicone prostheses of the mammary glands;

Puncture biopsy of formations under ultrasound control.

Stomach

1. Examination of the parenchymal organs of the digestive system (liver, pancreas):

Diagnostics of focal and diffuse diseases (tumors, cysts, inflammatory processes);

Diagnosis of injuries in mechanical trauma of the abdomen;

Identification of metastatic liver damage in malignant tumors of any localization;

Diagnosis of portal hypertension.

2. Examination of the biliary tract and gallbladder:

Diagnosis of gallstone disease with an assessment of the state of the biliary tract and the determination of stones in them;

Clarification of the nature and severity of morphological changes in acute and chronic cholecystitis;

Ultrasound is the most popular and most accurate diagnostic method that is used during pregnancy for both
its diagnosis, determining the duration of pregnancy, assessing the correct development of the fetus and identifying possible violations, as well as assessing the growth of the fetus, determining the risk of miscarriage and premature birth. This study is in no way dangerous to either the mother or the development of the child, and can be performed multiple times during pregnancy, although scientific advice requires ultrasound to be performed only three times during pregnancy. Depending on the gestational age, it can be performed using a vaginal probe or as standard, through the abdominal membranes. At an early stage, the transvaginal examination is the most accurate. Since ultrasound has different purposes depending on the gestational age, different measurements are performed and different structures are evaluated accordingly. It is important that ultrasound at each stage of pregnancy with a high probability allows us to conclude whether the fetus is developing correctly.

ultrasound during pregnancy
Ultrasound during pregnancy The most important is the study in the first trimester, because it ...
According to modern requirements, it is recommended to perform an ultrasound examination three times during pregnancy. The first - between the 11th and 14th weeks of pregnancy, in order to most accurately determine the duration of pregnancy. The second - between the 18th and 22nd weeks - to assess the structure of the fetus and its size, and the third after the 30th week of pregnancy, to assess its growth. It follows from this that an early examination between the 5th and 10th weeks of pregnancy is not at all necessary if the pregnancy proceeds correctly, but it is usually performed. It allows, first of all, to obtain an image of the fetal bladder in the uterine cavity, as well as to estimate the gestational age based on its size. In addition, this study also allows you to get an image of the cardiac activity of the fetus and determine the frequency of cardiac activity.

Obtaining an image of the embryo in the cavity and the manifestation of the activity of its heart are reliable signs of pregnancy, allowing it to be diagnosed. The fetal bladder is visible on ultrasound from about the 4th week, at which time its size is about 3-4 mm, and grows by more than 1.1 mm per day. Fetal heart activity appears around the 6th week of pregnancy. After the 11th week, the embryo becomes a fetus. On the basis of an ultrasound examination between the 5th and 10th weeks, it is also possible to diagnose a threatened miscarriage and ectopic pregnancy.

Ultrasound examination between the 11th and 14th weeks of pregnancy
This is a study that should be carried out according to scientific recommendations. It serves primarily to accurately estimate the gestational age based on the measurement of the parietal-coccygeal length of the CRL. In addition, it allows you to diagnose multiple pregnancies, as well as determine whether they are single or twin twins based on the number of amniotic sacs, chorions and amnions. In addition, the cardiac activity of the fetus is assessed, which makes it possible to determine the risk of heart defects and fetal chromosomal aberrations. During this study, the fetal anatomy is studied for the first time, obtaining an image of the skull, abdominal wall, stomach, fetal heart, bladder, upper limbs, with a detailed representation of the hand, as well as the lower limbs. Such a study allows you to make a preliminary assessment of the risk of developing disorders in the fetus. Between the 11th
and the 14th week of pregnancy, the thickness of the collar space of the NT is also determined, and an image of the nasal bone of the fetus is obtained, which makes it possible to assess the risk of developing Down syndrome in the fetus.

Ultrasound examination between the 18th and 22nd and after the 30th week of pregnancy
The purpose of this study is to diagnose most of the organs and analyze the size of the fetus. This allows early detection of developmental disorders and high-risk pregnancies. During this study, an image of the fetal skull is obtained and its integrity, shape and size are determined. In addition, the structure of the brain, face, neck, and spinal continuity must also be assessed.

The next stage is an assessment of the structure and work of the heart, the structure of the chest, abdominal cavity, as well as the structure and size of the limbs. This diagnosis allows to identify such defects as cerebral and spinal hernias, hydrocephalus, diaphragmatic hernia and hernia of the umbilical cord, gastroschisis, overgrowth of the duodenum, narrowing of the intestine and tumors of the fetus.

Obtaining an image of the fetal heart and evaluation of its structure, in turn, can reveal serious heart defects such as tetralogy of Fallot, transposition of the great vessels, narrowing of the aorta, and defects in the heart walls. In an ultrasound examination between the 18th and 22nd weeks of pregnancy, in addition, an accurate assessment of the dimensions of the fetus, such as biparietal head size (BPD) and head circumference, abdominal circumference and thigh length, is carried out. This allows you to determine whether the fetus is growing correctly and whether its growth corresponds to the gestational age.

At this time, they also examine the placenta, its location in the uterine cavity, its degree of maturity, the vessels of the umbilical cord, and evaluate the volume amniotic fluid(their small volume may indicate serious disorders of the urinary system, and also poses a risk for the proper development of the fetus). The study after the 30th week of pregnancy is performed only in order to assess the growth of the fetus and, if necessary, to estimate its weight at the date of birth.

The interpretation of ultrasound readings is carried out by two specialists - a doctor who conducts an ultrasound examination, and a leading gynecologist. The ultrasound doctor issues a conclusion with the established gestational age and information about the existing pathologies of fetal development or their absence. The gynecologist also assesses the degree of pathologies and decides what to do next for the pregnant woman.

Why do you need an ultrasound during pregnancy

Conducting an ultrasound analysis is caused by the need to examine the child in the womb for its pathologies or their absence.

Early ultrasound is carried out to determine the presence of pregnancy and its duration, the number of fetal eggs. This way of research is useful in that it can reveal an ectopic pregnancy - a dangerous condition that requires immediate medical intervention, up to surgical methods. If, with the help of ultrasound, this pathology is detected in the initial stages, the pregnant woman has the opportunity to avoid surgical intervention.

At the stage first screening (11-13 weeks) the walls of the uterus, the uterus itself and its appendages are studied, and the following indicators of the growth of the embryo are considered:

• chorion - it contributes to the development of the placenta;
• The yolk sac is an important component for the development of the embryo.

At the next ultrasound helps to identify existing pathologies, such as, the threat of miscarriage,. It is the timely diagnosis of deviations that helps to eliminate them and avoid subsequent complications.

At the second screening a number of indicators are examined, which then will need to be deciphered:

• the uterus, fallopian tubes and the condition of the ovaries are examined;
• fetometry is carried out, with the help of which the sizes of individual parts of the fetus are established and their compliance with the gestational age is assessed;
• the state of the organs that connect the child with the mother (placenta, umbilical cord) is studied, the structure of the amniotic fluid is assessed;
• the state of the internal organs of the child is analyzed.

On this ultrasound, some pathologies can be traced, such as oligohydramnios or too low attachment of the placenta. Thanks to ultrasound, it is possible to establish both curable and incurable fetal defects.

Third screening carried out for the following purposes:

• identification of serious fetal malformations that cannot be detected in the early stages;
• determination of fetal presentation (gluteal or head);
• determination of the body weight of the child;
• assessment of the risk of abnormal formation of the brain;
• examination for a subject;
• evaluation of the fetal heart rate - rapid or rare;
• assessment of fetal growth;
• assessment of the risk of developing heart defects in the fetus.

On ultrasound in the third trimester, you can already see the baby's lungs and their readiness to work in a normal environment in case of premature birth. In the last screening, great attention is paid to the skull, abnormalities such as cleft palate, cleft lip, etc. are monitored.

On the eve of the birth itself, ultrasound allows you to find out some of the nuances that may be important for the birth process itself. In particular, only thanks to ultrasound it is possible to see the entwined umbilical cord with 100% accuracy, and this is a very important aspect in the birth process, because it can become a threat both to the health of the baby and to his life.

Some pregnant women are prescribed Ultrasound more often than expected. These pregnant women include those who have: diabetes mellitus, blood and lymph diseases, negative Rh factor.

Deciphering fetal ultrasound

Already starting from the 11th week of pregnancy, the detection of fetal pathologies is allowed. In Russia, two main standard protocols are defined, according to which data is decrypted.

These studies are conducted at 11-13 weeks of pregnancy and at 19-22 weeks. In order to more accurately decipher the data, you need to know the norms of fetal development at different stages of gestation.

At this time, a detailed examination of the collar zone of the fetus is carried out - the area between the tissues and the skin in the neck area. The thickness of the collar zone is abbreviated as TVP. Normally, TVP should not exceed 2.7 mm.

The nasal ossicle is another parameter that is being investigated at this time. Normally, the bone should be visualized.

Another indicator that is measured at this stage is KTR (coccyx-parietal size of the fetus).

For a kid at 11 - At week 13, the KTR is considered to be within 45-80 mm.

In addition to KTR, the doctor evaluates the biparietal and fronto-occipital dimensions of the fetus. The first is the distance from one temple of the head to another and is normally up to 28 mm. The second - the distance from the frontal to the occipital bone - normally does not exceed 31 mm.

* Percentile is a descriptive statistics term. The average value is indicated in the "50th percentile" column, in the "5th percentile" and "95th percentile" columns - the minimum and maximum allowable values, respectively.

Separately, the doctor evaluates the diameter of the fetal egg ...

... and calculates the heart rate (HR).

If the indicators do not correspond to the norm, the pregnant woman is recommended to undergo a consultation with a geneticist and an additional examination.

Second fetal screening

The norms of fetal development in the second trimester are shown in the table:

* Percentile is a descriptive statistics term. The average value is indicated in the "50th percentile" column, in the "5th percentile" and "95th percentile" columns - the minimum and maximum allowable values, respectively.

If there are any changes in these indicators, deviations in the development of the child in the womb can be assumed. By the way, during the second screening, the fetus is seen much better than during the first one, so the doctor can judge not only genetic abnormalities, but also other defects (they are recorded separately in the examination protocol).

As part of the third screening, such baby parameters as height, weight, biparietal head size, hip and chest length are evaluated. The norms of the listed parameters are described in the table above. Below are the normal indicators of BDP and LZR.

* Percentile is a descriptive statistics term. The average value is indicated in the "50th percentile" column, in the "5th percentile" and "95th percentile" columns - the minimum and maximum allowable values, respectively.

During the 3rd screening, the doctor evaluates the condition of the placenta, its degree of maturity and thickness. The placenta is the link between a mother and her baby. It remains for the entire duration of pregnancy. It exists in order to nourish the child with the necessary nutrients.

IAI norms (amniotic fluid index)

Fetal size by week of pregnancy

Each trimester has its own research and measurements. The interpretation of ultrasound indicators helps to establish the size of the child at the time of its development.

Below is a table of the size and weight of the fetus by week. It is worth saying that the readings are average, may differ from reality. This is especially true in the last months of pregnancy.

A newborn can be born with a weight of 2300 grams, or it can be born with a weight of 4500 grams. And in fact, and in another case, he can be absolutely healthy.

Ultrasound examination of the placenta

Ultrasound of the placenta determines its size, echostructure, development.

When the placenta may be hyperthick:

at detachment;

with Rhesus conflict;

with dropsy of the embryo;

mild thickening may occur in women with diabetes mellitus;

if in the process of bearing a pregnant woman suffered an infectious disease.

The placenta has the same functions as the human body - it tends to be born, mature and fade. All these moments are absolutely natural. But if it happens, it is a pathology.

Exists 3 degrees of maturity of the placenta:

Idegree of maturity. Until the 30th week of pregnancy, the placenta is at the zero degree of maturity. At this time, it increases in size, nourishing the baby with all the useful elements. The structure is normally homogeneous, smooth. After 30 weeks, specks and waves may appear on the placenta, which indicate the beginning of the maturation of the placenta. If the appearance of these signs is detected earlier, then this process is called "premature aging of the placenta." In some cases, women are prescribed medication. The first degree should last up to 34 weeks.

IIdegree of maturity. This degree comes from 34 to 37 weeks. It already looks more prominent, wavy, the ultrasound shows an echostructure with speckles. If the second degree indicates early term than 34 weeks, then it will be necessary to undergo a more detailed diagnosis and CTG of the fetus. All tests as a whole will show if there are any fetal pathologies. If the child suffers from hypoxia, outpatient treatment may be prescribed.

IIIdegree of maturity. This degree is established already at full-term pregnancy. The placenta is preparing for childbirth and its functions are reduced, its natural aging occurs. There are large waves and salt deposits all over the surface.

If the placenta does not correspond to its term, then there is a risk of premature birth.

Ultrasound of the umbilical cord of the fetus

An umbilical cord passes between the placenta and the fetus, which connects them together. Ultrasound examination determines the number of vessels in the umbilical cord, their condition, structure.

The umbilical cord has two arteries and one vein that feed the fetus. The vein saturates the fetus with oxygen, and the arteries serve as the output of processed products.

The length of the umbilical cord should normally be at least 40 cm.

Ultrasound allows you to see the entanglement of the umbilical cord, if any. Establishment of entanglement is not yet a reason for a caesarean section.

Ultrasound examination of amniotic fluid

In the process of ultrasound, the amniotic index is calculated, which indicates the amount of water. The index is measured according to a certain scheme:

the uterus is divided into two perpendicular strips, one goes along the navel line, the other longitudinally;

in each sector, measurements of the free distance between the fetus and the wall of the uterus are made;

indicators are summed up.

Normal values ​​​​at week 28 will be AI readings of 12-20 cm. An increase in the value may indicate polyhydramnios, a decrease in indicators, respectively, of oligohydramnios.

* Percentile is a descriptive statistics term. The average value is indicated in the "50th percentile" column, in the remaining columns - the minimum and maximum allowable values, respectively.

In any case, this or that deviation indicates violations in the blood supply to the placenta.

Ultrasound of the uterus during pregnancy. The size of the uterus by week of pregnancy

When conducting an ultrasound of the uterus, its size is measured, its appearance is examined for the presence of myomatous nodes, muscle tone, and the thickness of the walls of the uterus is measured.

Before pregnancy, the thickness of the walls of the uterus is 4-5 cm, by the end of pregnancy, the uterus is stretched, its walls become thinner and are approximately 0.5-2 cm.

The normal length of the cervix is ​​3.5-4.5 cm.

Marianna Artemova, obstetrician-gynecologist, specially for website

Synonyms for ultrasound examination of the pelvic organs: Ultrasound, Ultrasound examination in gynecology.

SUBSTANTIATION OF THE METHOD OF ULTRASONIC EXAMINATION (US) OF THE PELVIC ORGANS

The ultrasound method is widely used, safe, highly informative, not burdensome, economical, and can be used repeatedly.

PURPOSE OF THE METHOD OF ULTRASOUND EXAMINATION (US) OF THE PELVIC ORGANS

Identification of various diseases of the reproductive system.

INDICATIONS OF ULTRASOUND EXAMINATION (US) OF THE PELVIC ORGANS

Suspicion of the presence of various gynecological pathologies, urgent conditions, treatment control, screening studies.

CONTRAINDICATIONS FOR ULTRASOUND EXAMINATION (US)

There are no contraindications for the study.

PREPARATION FOR ULTRASOUND OF THE PELVIC ORGANS

In virgins and with volumetric formations located above the uterus, the study is carried out with a filled bladder or transrectally.

METHOD FOR CARRYING OUT ULTRASONIC EXAMINATION (US) OF THE PELVIC ORGANS

For echography, devices with sectoral transabdominal and vaginal sensors are used. The frequency of the first of them is 3.5-5 MHz, the second - 5-7.5 MHz. When using transabdominal sensors, the study is carried out in conditions of a filled bladder. Before using the vaginal sensor, it is subjected to special treatment, then a sound-conducting gel is applied to its scanning surface and a condom is put on. In women of childbearing age, the study is preferably carried out immediately after the end of menstruation or 1-3 days before it begins.

Dopplerography determines the number of vascularization zones, the presence or absence of blood flow mosaic, as well as blood flow velocity indicators: pulsation index (PI), resistance index (IR) and maximum systolic blood flow velocity (Vc).

INTERPRETATION OF THE RESULTS OF ULTRASOUND EXAMINATION (US) OF THE PELVIC ORGANS

The interpretation of echograms is carried out on the basis of an analysis of the internal structure of the formation, its echogenicity, sound conductivity and contour assessment. After completion of the study, they give a conclusion about the structure of the formation (cystic, solid cystic, solid) and, if possible, make a conclusion about its nosological affiliation. Dopplerography has the greatest clinical significance in the differential diagnosis of benign and malignant ovarian tumors. The most characteristic Dopplerographic signs of a malignant process are the presence of a large number of vascularization zones, mosaic blood flow, low PI values ​​(<0,6) и ИР (<0,45) и высокая Vc.

Sonography is currently considered the leading research method in gynecology. The use of this method not only helps to identify various pathological processes of the organs of the reproductive system in women, but in most cases makes it possible to establish their nosological affiliation.

Normal ultrasound readings

The shape and size of the uterus according to ultrasound, the norm: It was found that the normal uterus has a pear-shaped shape. Its length in women of childbearing age is on average 5.0 cm (4.5–6.7 cm), thickness 3.5 cm (3.0–4.0 cm) and width 5.4 cm (4.6– 6.4 cm). In the postmenopausal period, the size of the uterus decreases significantly and 20 years after the end of menstruation, its length averages 4.2 cm, thickness 3.0 cm and width 4.4 cm. from the phase of the menstrual cycle. In the first days of the menstrual cycle, the uterine cavity can be expanded to 0.1-0.4 cm, on the 3rd-4th day of the cycle, the thickness of the endometrium is 0.1-0.4 cm, on the 5th-6th day 0.3-0.6 cm, on days 8–10 0.6–1.0 cm, on days 11–14 0.8–1.5 cm, on days 15–18 1.0–1.6 cm, on days 19–23 1 0-2.0 cm and on the 24-28th day 1.0-1.7 cm. It should be noted that normally throughout the entire menstrual cycle, the endometrium should be homogeneous, in the 1st phase of the cycle anechoic and by the end of the 2nd phase hyperechoic.

Ovarian sizes in women of childbearing age, they average 3.6 cm in length (3.0–4.1 cm), 2.6 cm in width (2.0–3.1 cm), and 1.9 cm in thickness (1. 4–2.2 cm). In the ovarian parenchyma, transvaginal scanning reveals multiple elements of the follicular apparatus with a diameter of 0.3–0.6 cm, and in the middle of the cycle, a dominant follicle with a diameter of 1.8–2.4 cm. anechoic or heterogeneous structure with thick walls with a diameter of about 2.0 cm, which gradually decreases in size by the beginning of the next cycle. After menopause, the follicular apparatus disappears and the size of the ovaries gradually decreases.

Anomalies in the development of the uterus and vagina are quite rare and the most difficult pathology to diagnose. All this leads to the fact that in a significant number of cases, patients are subjected to unjustified, including multiple, surgical interventions. Currently, there are a fairly large number of classifications of uterine and vaginal malformations, but the classification proposed by V.N. Demidov in 2006

Classification of malformations of the uterus and vagina:

●plasia of the uterus and vagina;
●plasia of the vagina with a functioning or non-functioning uterus;
●plasia of the uterus in the presence of the vagina;
● hypoplastic uterus;
●infantile uterus;
●rudimentary uterus;
●complete doubling of the genitals;
● bicornuate uterus with incomplete symmetrical doubling of it, with one or two necks, with the absence or presence of a septum in the vagina;
● bicornuate uterus with incomplete doubling with the presence of a hypoplastic or hyperplastic horn connected or not connected to the cavity of the main uterus;
● bicornuate uterus with complete symmetrical doubling of it, with one or two necks, with the absence or presence of a complete or incomplete septum in the vagina;
● bicornuate uterus with its complete doubling, with the presence of hypoplastic or hyperplastic non-functioning or functioning horn, connected or not connected to the cavity of the main uterus;
● bicornuate uterus with its complete doubling, with the presence of a rudimentary horn, presented in the form of a strand or cord;
● bicornuate uterus with its complete doubling, with the presence of hypoplastic or hyperplastic non-functioning horn connected to the main uterus by means of a cord;
● bicornuate uterus with its complete doubling, with the presence of a hypoplastic or hyperplastic non-functioning or functioning horn completely isolated from the main uterus;
● bicornuate uterus with its complete doubling, with the presence of functioning or non-functioning one or two semi-uteri in combination with vaginal aplasia;
● complete or incomplete separation of three or four semi-uteri, with the presence of functioning or non-functioning connected or not connected to the cavity of the main uterus, hypoplastic or hyperplastic one or two horns;
●unicornuate uterus;
● saddle uterus;
● uterus with complete or incomplete septum;
●aplasia of the cervix or atresia of the cervical canal in the presence of a functioning or non-functioning uterus;
●atresia of the hymen;
● aplasia of the upper, middle or lower third of the vagina in combination with hematocolpos and possibly with hematocervix or hematometra;
● bicornuate uterus with complete or incomplete doubling of it with the presence of two necks, a septum into the vagina and atresia of one of them at various levels in combination with hematocolpos and, possibly, with hematocervix and hematometra.

In the classification, the doubling of the neck can be replaced by a longitudinal septum, if the latter is present.

With aplasia of the uterus and vagina (Rokitansky-Küster-Meyer syndrome) the images of these organs are absent on the scans. At uterine hypoplasia on scans, a reduced uterus is revealed, the cervix is ​​hypoplastic in most cases, Maho is either in the form of a thin strip or is not detected at all. At functioning uterus and vaginal atresia almost always reveal a hematometer, which can be combined with hematosalpinx. At lower vaginal atresia on scanograms, hematocolpos of varying severity is determined. At aplasia of the uterus and the presence of the vagina the uterus is either not detected at all, or it is depicted as one or two rollers located in the region of the proximal end of the vagina.

There are several options for underdevelopment of the uterus. With hypoplasia, the uterus is reduced in size, but the ratio between the length of the uterus and the cervix remains the same as normal, i.e. 2:1. The most accurate idea of ​​the severity of hypoplasia can be obtained by measuring the volume of the uterus. However, for practical purposes, you can limit yourself to only measuring the thickness of the uterus. This is due to the fact that the thickness of the uterus with hypoplasia is reduced more than its other sizes. With degree I hypoplasia, the thickness of the uterus is 2.9-2.5 cm, with degree II 2.4-2.0 cm and with degree III 1.9-1.5 cm. For infantile uterus characterized by an even more pronounced decrease in its size compared to the norm. The length of the uterine body is equal to the length of a poorly differentiated cervix, and their ratio is 1:1.

The thickness of the uterus in infantilism is 1.5–1.0 cm. Mecho is often unexpressed. The rudimentary uterus is considered an extremely rare form of its underdevelopment. The thickness of the uterus is less than 1.0 cm. Most of the uterus falls on the cervix. On ultrasound, the uterus is depicted as a cord without a clear differentiation into the body and neck.

From an embryological standpoint, a unicornuate uterus is half of a normal uterus. The length and thickness of the uterus fluctuate within normal limits. At the same time, the width of the uterus in this pathology is significantly reduced and varies between 3.4–4.2 cm. Another important sign of a unicornuate uterus is the asymmetry of its side walls. Moreover, a thicker wall is located on the side of the undeveloped horn. Also noteworthy is a significant decrease in the width of the endometrium in a unicornuate uterus. So, if with a normal uterus the endometrium has an elongated shape, then with a unicornuate uterus it is oval or round. Helps in the diagnosis of a unicornuate uterus by measuring the wall thickness near its corners with a longitudinal scan. It has been established that normally the difference in the thickness of the uterus in the region of its corners should not be more than 0.1–0.2 cm when measured from each side. At the same time, with a unicornuate uterus, this difference is 0.5–1.0 cm. Moreover, the thicker wall is located on the side of the defect.

According to most authors, the most characteristic sign of the saddle uterus- Maho divergence in the area of ​​its bottom during transverse scanning. However, it should be borne in mind that the indicated echographic sign is also observed with a septum, an incomplete form of uterine duplication, and in 8–10% of cases with a normal uterus. For the diagnosis of the saddle uterus V.N. Demidov proposed to determine the amount of bulging of the myometrium in the area of ​​its bottom. For this purpose, in women who have a Maho divergence in the fundus, longitudinal scanning measures the distance from Maho to the outer surface of the uterus near each of its corners, as well as the maximum distance between Maho and the outer surface of the uterus in the fundus. The difference in the thickness of the muscle, measured in the center and in the region of its corners, is taken as the magnitude of the bulging of the myometrium. It has been established that if the bulging of the myometrium in the fundus is 1.0–1.4 cm, this indicates the presence of a saddle uterus. At the same time, a decrease in this value to 0.9 cm or less indicates the normal development of the uterus, and its increase to 1.5 cm or more indicates a bicornuate uterus or the presence of a septum.

In the presence of a septum, the length, thickness, and width of the uterus vary within normal limits. The value of Maho's discrepancy during transverse scanning is 0.7–1.7 cm (average 1.17 cm).

At incomplete form of doubling of the uterus, as in the presence of a septum, the uterus looks like a single organ. The main distinguishing feature of the incomplete form of doubling the uterus is considered to be a significant increase in its width to an average of 6.5 cm (individual fluctuations - 5.8–7.7 cm). Another important sign of the pathology under consideration is a significantly larger Maho divergence compared to the septum during transverse scanning in the bottom area: on average, up to 2.75 cm (2.0–4.1 cm). It should be noted that with an incomplete asymmetric form of doubling of the uterus, one of its halves may be smaller than the other. Moreover, in some cases this difference is quite significant. In this case, the hypoplastic horn can be both functioning and non-functioning, connected or not connected to the main horn. In the latter case, a hematometer is often observed in a hypoplastic functioning horn, which in some cases can be mistaken for endometriosis with a cystic cavity. It should be noted that the incomplete form of duplication of the uterus is sometimes combined with two necks and a longitudinal septum in the vagina.

At full form doubling the two half-wombs diverge at a large angle. With a bicornuate uterus with its complete symmetrical doubling, the length and thickness of the horns remain almost the same as in the absence of this pathology. At the same time, the width of each of the horns is approximately 2/3 of the normal value. In the case of hypoplasia of one of the horns, it can be functioning open, functioning closed and non-functioning.

Extremely rare options for the full form of doubling the uterus are:

●rudimentary horn in the form of a strand or cord;
● the rudimentary horn is connected to the main uterus by means of a cord;
● The rudimentary horn is completely separated from the main uterus.

A special group of anomalies are atresia and aplasia of the middle and lower parts of the reproductive system. With aplasia of the neck and atresia of the cervical canal, a hematometer and, possibly, a hematosalpinx are detected. With atresia of the vagina at different levels, hematocolpos and hematometra are determined with different severity. Sometimes there may be a hematosalpinx.

In case of atresia of the hymen on scans in the lower parts of the pelvis, various sizes of an elongated-oval shape of a liquid formation are revealed. With a significant size of hematocolpos, hematocervix, hematometer, and sometimes hematosalpinx are often observed.

Anomalies in the development of the internal genital organs are combined with malformations of the kidneys, which should be paid special attention to when performing echography.

●reduction of the uterus, mainly its thickness;
●an increase in the size of the ovaries;
●absence of a dominant follicle or corpus luteum;
●an increase in the number and diffuse arrangement of follicles, as well as a decrease in differences in their size. To facilitate the diagnosis of this pathology, V.N. Demidov proposed to calculate the ovarian-uterine index, which is the ratio of the average volume of the ovary to the thickness of the uterus: Ovarian-uterine index \u003d 0.5 x / Mt, where Old, Olt, Olsh, Opd, Opt, Opsh are the length, thickness and width of the left and right ovaries, respectively, expressed in centimeters; Mt is the thickness of the uterus, also expressed in centimeters.

It has been established that if the ovarian-uterine index exceeds 3.5, then in 91% of cases this indicates polycystic ovaries, on the contrary, a decrease in this indicator below the threshold value in 85% indicates the absence of pathology.

Diagnosis ovarian failure syndrome valid in women under 40 years of age. On scans of the pelvic organs with this pathology, a reduced uterus and ovaries are detected, the dimensions of which approximately correspond to the postmenopausal period. Maho usually has the appearance of a thin strip. The follicular apparatus is not defined.

Cysts are a very common pathology of the ovaries. These are mainly follicular cysts and cysts of the corpus luteum. Follicular cysts on scans, they are detected as round and, less often, as an oval formation. Their inner surface is even, smooth, the wall is thin, about 1 mm. The internal contents are homogeneous, anechoic. The diameter of cysts varies within 3-10 cm. Cysts disappear within 1-3 months after their occurrence. The shape of the corpus luteum cysts is mostly round, the wall is thick - 2–6 mm. The size of the cysts varies within 3–7 cm. The internal structure of the cysts is characterized by great diversity. The contents may be completely anechoic, have a cobweb-like or mesh structure, contain an irregularly shaped septum or hyperechoic inclusions (blood clots) of various sizes and shapes. Within 1-3 weeks, spontaneous disappearance of the cyst occurs.

At corpus luteum cysts, as in the corpus luteum, blood flow is determined in 95-100% of cases. Along with this, low values ​​of IR (0.32–0.46) are determined in combination with high Vc (1.5–42.5 cm/s). Thecalutein cysts occur with mole and OHSS. On scans, they are identified as unilateral or bilateral multi-chamber formations, the diameter of which is mainly 4–8 cm. The cyst wall is thin, about 1 mm. The contents of the cysts are homogeneous, anechoic. After the elimination of the pathological process, the cyst gradually disappears.

Endometrial cysts on scans, they are depicted as round or oval formations, located mainly behind the uterus. In a significant number of cases they are bilateral and multiple. In connection with the adhesive process in the small pelvis, they do not move during palpation. The size of the cysts is different (mainly from 1 to 8 cm). Their wall thickness varies within 2–6 mm. The internal contents of the cysts are filled with a highly or moderately echoic suspension that is not displaced by percussion of the formation. One of the main echographic signs of an endometriodine cyst is the presence of a double contour of its wall. Blood flow in the wall of endometrioid cysts is recorded in 70–80% of cases. The value of IR varies within 0.46–0.65, and Vc varies within 6–18 cm/s.

Location paraovarian cysts may be different. Their sizes generally range from 3 to 12 cm. Sometimes cysts are found to be much larger. The cyst wall is thin, about 1 mm. The content of the cyst is mostly homogeneous, anechoic, sometimes a delicate fine suspension is detected, which is displaced during percussion of the formation. The only reliable echographic sign of a paraovarian cyst is the presence of a separate ovary. The size of teratomas mainly varies within 2-12 cm. The internal structure of these tumors is very diverse. The tumor can consist of only one hyperechoic component, which is fat, contain dense hyperechoic and cystic components of various sizes, a dense component that gives an acoustic shadow (bone, hair), have multiple small-striped inclusions or thin elongated hyperechoic structures (hair).

With teratomas, blood flow is usually not determined.

Cystadenomas are the most common ovarian tumors. There are serous and mucinous cystadenomas, which, in turn, are divided into smooth-walled and papillary. Small smooth-walled cystadenomas are mostly round, large - oval. Their size varies widely and is mainly 3–15 cm, and the wall thickness usually does not exceed 1 mm. The contents of cystadenomas are mostly homogeneous, anechoic, in some cases they contain a low-echoic suspension that is displaced by percussion. In approximately 1/4 of observations, partitions are determined inside the formation. The shape of papillary serous cystadenomas is mostly round. Their size is most often 3–12 cm, and the wall thickness varies within 1–2 mm.

Papillary cystadenomas are mostly unilocular. In a significant number of observations, a shifting medium echogenic suspension is determined in their cavity. The main echographic sign of these cystadenomas is the presence on their inner surface of single or multiple growths with a diameter of 0.3–1 cm, a round spongy structure. The shape of small mucinous cystadenomas is mostly round, large ones are oval. The size of these tumors in most cases varies within 4–20 cm. However, in some cases they can occupy the entire abdominal cavity. The characteristic ultrasound signs of these tumors are the presence of a finely dispersed, medium-echoic non-displaceable suspension, as well as the detection of multiple thin irregularly shaped septa. It is important to note that these two signs are observed only in mucinous cystadenomas that are 6 cm or more in diameter.

In benign epithelial tumors (serous smooth-walled and papillary cystadenomas, mucinous cystadenomas), blood flow in the septum or dense component is recorded in 1/4 of cases. IR varies within 0.31–0.69 (average 0.5), and Vc - 4.0–32.0 cm/s (average 10 cm/s).

Fibroma of the ovaries belong to the group of tumors of the sex cord and stroma of the ovary. These tumors have different localization. The shape of the tumors is round or oval. Their size varies from a few millimeters to huge sizes, in which the tumor can occupy the entire abdominal cavity. The most characteristic ultrasonic signs of fibromas are their anechoic internal structure and low sound conductivity. In isolated cases, single cystic structures are found in the parenchyma of fibroids, which is due to the appearance of areas of tumor necrosis. In fibroids, blood flow is determined in 10% of cases, there is no mosaic, IR is usually more than 0.50, and Vc does not exceed 0.8 cm/s.

Tecoma also belongs to the group of tumors of the sex cord and stroma of the ovary. In 50% of cases, the tumor is estrogen-producing. Basically, thecomas are located on the side of the uterus. In most cases, thecoma sizes vary within 3–15 cm. The surface of tumors is usually smooth, echogenicity is medium or increased, and the internal structure is homogeneous. Cystic inclusions in the parenchyma thecoma are extremely rare. The sound conduction of these tumors is generally medium or increased. With thecomas, blood flow is recorded in all observations. Its mosaicity is defined as 40%. IR varies within 0.39–0.52 (average 0.48), and Vc - within 0.5–27.0 cm/s (average 13.0 cm/s).

Granulosa cell tumors belong to the group of tumors of the stroma of the ovary. Clinically, the disease is manifested by hyperestrogenism. Tumors are more often located on the side of the uterus, and their sizes range from 3–15 cm. Formations of small sizes (3–5 cm) are solid, their echogenicity is medium or reduced. Tumors of medium size (6-9 cm) have an average echogenicity and increased sound conductivity. They quite often determine small liquid inclusions with clear, even contours. In tumors that are 9 cm in diameter or more, cystic inclusions of large sizes are often detected, and many of them have a spongy structure due to the large number of thin septa. Androblastomas are classified as sex cord and stromal tumors of the ovary.

These tumors are masculinizing. On scans, tumors are mainly defined as round or oval formations located on the side or above the fundus of the uterus. On average, the diameter of the androster is 10 cm. Their echogenicity is different, and the sound conductivity is increased. In 1/3 of cases, the tumors have a solid structure.

The androster parenchyma is mostly heterogeneous due to the appearance in them of areas of increased echogenicity of various shapes and sizes and cystic inclusions. With androblastomas, arterial blood flow is noted in 100% of cases, mosaic - in 22% of cases. IR values ​​vary within 0.4–0.52 (average 0.45), Vс - 5.0–27.0 cm/s (average 11.4 cm/s). Dysgerminomas are germ cell tumors of the ovaries. The shape of the tumors is most often oval, the surface is bumpy. In most cases, tumors are located on the side or above the fundus of the uterus. Their structure, as a rule, is solid, the parenchyma is heterogeneous with areas of increased echogenicity of various sizes. The sound conductivity of dysgerminomas is high.

These tumors are characterized by rapid growth and early metastasis. With dysgerminomas, blood flow is detected in 100% of cases, its mosaic pattern is noted in 2/3 of cases. IR varies within 0.23–0.68 (average 0.5), and Vc - within 6.0–18 cm/s (average 12.3 cm/s). Ovarian cancer ranks first among all causes of death from tumors of the reproductive system in women.

For ovarian cancer the following echographic features are characteristic:

●increasing the thickness of the partitions;
●the appearance of fragmentary thickenings on them;
●detection of dense parietal components with a bumpy surface in a liquid formation of a round or oval shape;
● the presence of a large cystic-solid formation with a dense component or uneven, like cauliflower, inner surface;
● contour irregularity, increased echogenicity, heterogeneity of the internal structure and high sound conductivity of the formation in the case of a solid or solid cystic structure of the tumor.

Additional factors indicating the development of ovarian cancer include: the bilateral process, the presence of ascites, tumor infiltrates in the pelvis, an increase in pelvic, paraortal and paracaval lymph nodes. In ovarian cancer, intratumoral blood flow is noted in 98% of cases. In 78% it is mosaic, the IR value in this ovarian pathology varies within 0.24–0.62 (average 0.44), and Vc - within 0.4–40 cm/s (average 10.5 cm/s). OVZPM is also a fairly common pathology.

Abscess of the ovary on scans, it is detected as a formation of small size, round shape with thick walls, located in the parenchyma of the organ. The content of the abscess is represented by a medium or highly echogenic immovable fine suspension. The ovary is somewhat enlarged, the follicular apparatus is partially or completely absent. When pressing on it with a sensor, severe pain is determined.

Piovar has a similar internal structure. A distinctive feature of this formation is the presence of a large formation and the absence of an image of the ovary.

It should be noted that abscess and pyovar have a structure that is in many ways similar to the structure of an endometrioid cyst. For the differential diagnosis of these formations in a significant number of cases, one should focus on the clinical picture of the disease. Pyosalpinx on scans is defined as an oval or retort-shaped formation containing a medium or highly echoic, finely dispersed suspension that does not move during percussion, often separated by multiple partitions.

small hydrosalpinx on echograms, it may look like an elongated tubular structure filled with homogeneous anechoic content. With a hydrosalpinx not exceeding 2.5 cm in diameter, on its inner surface in a significant number of observations one can see multiple dense hyperechoic structures of small sizes, which are folds of the tube. Hydrosalpinxes of large sizes have an elongated oval or retort shape. In a significant number of observations, they are separated by multiple partitions and filled with a homogeneous liquid content. A characteristic feature of serozoceles is that in the vast majority of cases they occur after surgery and do not have their own wall. Their sizes vary from a few centimeters to the size of formations occupying the entire abdominal cavity. Their shape is mostly irregular or oval. The content is usually homogeneous, anechoic; sometimes the formation may contain a delicate, finely dispersed suspension displaced by percussion.

Diagnosis is of great practical importance chronic salpingoophoritis. The presence of this pathology is evidenced by the appearance in the ovarian albuginea of ​​single or multiple small (point) hyperechoic inclusions, as well as thin linear structures of various lengths located in the pelvis, which are adhesions. The presence of these anatomical changes in the vast majority of cases is combined with obstruction of the fallopian tubes. In conclusion, it should be noted that echography is a valuable diagnostic method, the use of which in the overwhelming majority of cases makes it possible to make a correct diagnosis of diseases of the internal genital organs and, based on the data obtained, decide on the choice of a rational method of treatment, taking into account the nature of the identified pathology.

OPERATING CHARACTERISTICS OF THE ULTRASOUND EXAMINATION (US) OF THE PELVIC

The sensitivity and specificity of the ultrasound method vary widely and range, respectively, from 25% and 50% for ovarian adenofibromas to 90% and 98% for functional cysts.

FACTORS AFFECTING THE RESULT OF ULTRASOUND EXAMINATION (US) OF THE PELVIC ORGANS

The sensitivity and specificity of the ultrasound method depends on the nature of the formation, its size, the experience of the researcher and the quality of the ultrasound equipment used.

COMPLICATIONS OF ULTRASOUND EXAMINATION (US) OF THE PELVIC ORGANS

When using this method, the occurrence of complications is not noted.

ALTERNATIVE METHODS

MRI, hysteroscopy and laparoscopy (alternative methods are selected for each specific gynecological disease).