HEMORRAGIA UTERINA ANORMAL - Medicina Fetal...Arduine,D. Ultrasound in Obstetrics & Gynecology 2009;...
Transcript of HEMORRAGIA UTERINA ANORMAL - Medicina Fetal...Arduine,D. Ultrasound in Obstetrics & Gynecology 2009;...
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HEMORRAGIA UTERINA ANORMAL
Diagnóstico por imágenes
Jaime Gómez DíazMedicina Fetal
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International Journal OG 2011; 113: 3-13
Sistema de clasificación PALM - COEIN
The FIGO classification of causes of
abnormal uterine bleedingMalcolm G. Munro, Hilary O.D. Crithcley, Ian S. Fraser, for the FIGO Working Group on Menstrual Disorders
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ULTRASONIDO EN LA
HEMORRAGIA UTERINA ANORMAL
OBJETIVOS
- Miomas
- Pólipos
- Adenomiosis
- Hiperplasia endometrial
- Ca endometrio
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2D DOPPLER 3D
HISTEROSONOGRAFIA
ULTRASONIDO
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PATOLOGIA MIOMETRIO - ENDOMETRIOPapel del ultrasonido?
• Tipo de masa
• Compromiso endometrial
• Removerla, ignorarla o seguirla
• Que clase de cirugía
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Ultrasonido - Miomas
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Miomas
Neoplasia más común del aparato reproductor.
En el 25% de mujeres en edad reproductiva.
La mayoría asintomáticas.
Degeneración maligna 0,2%.
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Miomas : Características al US
• ECOTEXTURA
Hipoecoico
Sombra acústica
• LOCALIZACION
Subseroso
Submucoso
Intramural
• NUMERO
• PSEUDOCAPSULA
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Miomas : Clasificación FIGO
International Journal OG 2011; 113: 3-13
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Miomas y Endometrio
Mejor evaluación en fase secretora
Delinear la exacta localización
Evaluar desplazamiento endometrial
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SHG – Miomas
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Doppler y miomatosis uterina
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SHG - 3D - Miomas
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SHG - 3D - Miomas
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Ultrasonido y Pólipos
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Pólipos Endometriales
Causa de HUA en postmenopausia
2.3 - 8.4%
riesgo de Ca Endometrio en 3- 9 veces
Se visualiza mejor en fase proliferativa
Dx diferencial Hiperplasia
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Ultrasonido y pólipos
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Doppler y pólipos
Vaso nutricio (pedículo)
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SHG – POLIPOS
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SHG - POLIPOS
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3D - POLIPOS
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Pólipo y Mioma
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ADENOMIOSIS
DEFINICION
Presencia de glándulas y estroma endometrial
en el miometrio asociado con hipertrofia e
hiperplasia miometrial.
Siegler AM & Camilien L. Adenomyosis. J Reprod Med 1994; 39: 841
Invasión unión endometrio - miometrio : 2.5 m.m.
Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312
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ADENOMIOSIS
C
L
I
N
I
C
A
Best Practice & Research Clinical O - G. 2006. Vol. 20, No. 4, 465.
%
Asintomática 35
Menorragia 40 - 50
Dismenorrea 15 - 30
Metrorragia 10 - 12
Dispareunía 7
Útero aumentado de tamaño, blando y sensible
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ADENOMIOSIS
PATOLOGIAS ASOCIADA
Best Practice & Research Clinical O - G. 2006.Vol. 20, No. 4, pp. 465.
Kairi Vassilatou, Eur J Gynaecol Oncol 2004; 25: 222
% Dx 1rio %
Miomas 64 69 - 79
Endometriosis pélvica 6 – 20 35 - 55
Pólipo endometrial 2,3 -
Hiperplasia endometrial sin atipias 7 -
Hiperplasia endometrial con atipias 3,5 35
Adenocarcinoma 1,4 60
Ferenczy A. Hum Reprod Update 1998; 4: 312
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Adenomiosis - Ultrasonido
INTERFASE ENDOMETRIO - MIOMETRIAL
Ultrasound Obstet Gynecol 2009; 34: 1–11
ZONA DE UNION
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Criterios de adenomiosis : US
Útero globular
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Criterios de adenomiosis : US
Asimetría miometrial A-P
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Criterios de adenomiosis : US
Escasa identificación unión endometrio -miometrial
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Criterios de adenomiosis : US
Estrías lineales ecogénicas subendometriales
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Criterios de adenomiosis : US
Quistes miometriales
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Criterios de adenomiosis : US
Quistes miometriales
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Criterios de adenomiosis : US
Miometrio heterogéneo
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Criterios de adenomiosis : US
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Uzan S, Ultrasound Obstet Gynecol 2001; 17: 177–178
Adenomiosis - Doppler
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Uzan S, Ultrasound Obstet Gynecol 2001; 17: 177–178
Adenomiosis - Doppler
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Adenomiosis - Ultrasonido 3D
Arduine,D. Ultrasound in Obstetrics & Gynecology 2009; 34 (Suppl. 1): 1–61
Halo subendometrial
Jurkovic D, Ultrasound Obstet Gynecol 2009; 34: 1–11
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Adenomiosis - Sonohisterografia
Verma SK, AJR 2009; 192:1112–1116
Mejora sensibilidad y precisión diagnóstica
Grietas endometriales
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Conclusión
El ultrasonido juega un papel fundamental y
primario en la evaluación de la paciente con
hemorragia uterina anormal.