Submucous Fibroid on Sonohysterography (ESGE G1 myoma) скачать в хорошем качестве

Submucous Fibroid on Sonohysterography (ESGE G1 myoma)

Here I present the technique of SONOHYSTEROGRAPHY for the diagnosis and preoperative imaging assessment of a submucous fibroid (submucous myoma, submucous leiomyoma). Submucous myomas are classified by the European Society for Gynaecological Endoscopy (ESGE) as type 0, 1, or 2. Type 0 submucosal fibroids are entirely located within the endometrial cavity, whereas type 1 fibroids have an intramural component of less than 50% of their diameter. Hysteroscopic myomectomy is most successful for type 0 and 1 fibroids. Type 2 submucosal fibroids have an intramural component that exceeds 50% of their diameter and typically require resection via laparotomy or laparoscopy. A complete characterization of the patient's pelvic anatomy with transvaginal ultrasound and sonohysterography is required prior to surgery. Sonohysterography is a technique that helps improve visualization of the endometrium and endometrial cavity, and distinguish between lesions of endometrial and myometrial origin. It involves placing a catheter into the uterine cavity through the cervical os to inject sterile saline into the endometrial canal during transvaginal ultrasonography. The saline distends the cavity, pushing the opposed walls of the endometrium apart. The anechoic fluid is juxtaposed against the echogenic endometrium, giving exquisite detail of the uterine lining. The indications for sonohysterography include the evaluation of: abnormal uterine bleeding; uterine cavity, especially with regard to uterine leiomyomas, polyps, and synechiae; abnormalities detected on transvaginal ultrasonography, including focal or diffuse endometrial or intracavitary abnormalities; congenital abnormalities of the uterus; infertility; and recurrent pregnancy loss. In this sonohysterography example we observe the typical appearance of an ESGE type 1 submucous fibroid. These lesions are hypoechoic, broad based, and well circumscribed, and they displace the endometrium to varying degrees. Note the echogenic endometrium flowing over the submucosal mass (the presence of overlying endometrium helps distinguish between submucosal and mucosal abnormalities).The percentage of protrusion of the fibroid into the endometrial cavity can be classified as greater than 50%. Stavros Mousourakis (Mussurakis), MD, FRCR Clinical Radiologist Ultrasound, Fetal & Women's Imaging Specialist ΣΤΑΥΡΟΣ ΜΟΥΣΟΥΡΑΚΗΣ