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3. sacd viem phan phu.10.2017.vsum.medic.k23

The Nhan Huynh
The Nhan Huynh

Bi gi畉ng si棚u 但m s畉n ph畛 khoa 2017

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SIU M CH畉N ON VIM PH畉N PH畛 1 Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
VIM NHI畛M VNG CH畉U (PELVIC INFLAMMATORY DISEASE PID) B畛nh l箪 vi棚m nhi畛m v湛ng ch畉u (pelvic inflammatory disease PID) g畉p kh叩 nhi畛u 畛 ph畛 n畛. B畛nh th動畛ng lan truy畛n qua 動畛ng t狸nh d畛c, l畉u c畉u (gonorrhea) v chlamydia l 2 t叩c nh但n th動畛ng g畉p. Nhi畛m tr湛ng th動畛ng i vo tr畛c ti畉p qua k棚nh c畛 v n畛i m畉c t畛 cung. 担i khi nhi畛m tr湛ng qua m畛t 畛 vi棚m nhi畛m k畉 c畉n. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
Nhi畛m tr湛ng qua 動畛ng m叩u r畉t hi畉m g畉p v th動畛ng do lao (tuberculosis). T畛n th動董ng th動畛ng 畛 c畉 hai b棚n (tr畛 tr動畛ng h畛p lan truy畛n t畛 畛 nhi畛m tr湛ng k畉 c畉n). S畛 hi畛n di畛n c畛a v嘆ng tr叩nh thai lm tng nguy c董 vi棚m nhi畛m v湛ng ch畉u. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
H畉u qu畉 l但u di c畛a b畛nh l箪 ny l t狸nh tr畉ng au v湛ng ch畉u m畉n t鱈nh (chronic pelvic pain), v担 sinh v tng nguy c董 thai l畉c ch畛. Vi棚m nhi畛m kh畛i 畉u 畛 c畛 TC, lan vo n畛i m畉c TC (endometritis), r畛i v嘆i tr畛ng (acute salpingitis) v cu畛i c湛ng l v湛ng bu畛ng tr畛ng hai b棚n v mng b畛ng. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
V嘆i tr畛ng b狸nh th動畛ng di kho畉ng 10cm, c坦 動畛ng k鱈nh t畛 1-4mm, th動畛ng kh担ng th畉y tr棚n si棚u 但m, tr畛 khi c坦 d畛ch bao quanh.
L但m sng: b畛nh nh但n th動畛ng au, s畛t, cng t畛c v湛ng ch畉u, ra m畛 但m 畉o. Si棚u 但m qua ng達 b畛ng th動畛ng kh坦 ch但n oan b畛nh l箪 ph畉n phu味. Si棚u 但m qua ng達 但m 畉o 坦ng vai tr嘆 quan tr畛ng trong ch但n oan b畛nh. Ta c坦 2 th畛 ch鱈nh: Th畛 c畉p t鱈nh. Th畛 m畉n t鱈nh. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 7
Fluid-pus level 8
VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c ph湛 n畛 t畉o thanh. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 9
V嘆i tr畛ng b狸nh th動畛ng COGWHEEL SIGN SIGNE DE LA ROUE DENTEE Vi棚m c畉p t鱈nh 10
C畉t d畛c theo voi tr畛ng: Day thanh voi tr畛ng hai b棚n. 11
12
Cogwheel sign 13
VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 14
Hydrosalpinx v畛i cogwheel sign N. Perrot et al. Echographie Endovaginale-Doppler couleur en Gynecologie-Obstetrique. 5e 辿dition. 2004 The Netter Collection OF MEDICAL ILLUSTRATIONS. Reproductive System. 2011 by Saunders, an imprint of Elsevier Inc. 15
VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). - Vi棚m bu畛ng tr畛ng (oophoritis): Bu畛ng tr畛ng to ra, c坦 nhi畛u nang nh畛 (c坦 th畛 l畉m v畛i bu畛ng tr畛ng a nang). - Th但m nhi畛m m畛 m畉c treo v湛ng h畉 v畛, quanh t畛 cung. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 16
17
Acute PID Chronic PID Sub-acute PID The Netter Collection OF MEDICAL ILLUSTRATIONS. Reproductive System. 2011 by Saunders, an imprint of Elsevier Inc. 18
VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong m畛 (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 19
V嘆i tr畛ng b狸nh th動畛ng Vi棚m m畉n t鱈nh BEADS-ON-STRING SIGN SIGNE DES PERLES SUR UN FIL 20
21
22
23 RIGHT PYOSALPINX
24 RIGHT PYOSALPINX
25 RIGHT PYOSALPINX
Fluid-pus level Pus with gas HYRDOSALPINX PYOSALPINX 26
VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong d畛ch (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). - p xe v嘆i-bu畛ng tr畛ng (tubo-ovarian abscess - TOA): ph畛c h畛p v嘆i- bu畛ng tr畛ng c坦 v叩ch dy, tng t動畛i m叩u 畛 v叩ch, h畛i 但m m畉t k鱈nh m畛. - D畛ch t炭i c湛ng. 27
Peter M. Doubilet et al. Atlas of ultrasound in obstetrics and gynecology. 2012 TOA 畛 hai b畛nh nh但n. 28
VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). - Vi棚m bu畛ng tr畛ng (oophoritis): Bu畛ng tr畛ng to ra, c坦 nhi畛u nang nh畛 (c坦 th畛 l畉m v畛i bu畛ng tr畛ng a nang). - Th但m nhi畛m m畛 m畉c treo v湛ng h畉 v畛, quanh t畛 cung. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 29
VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong d畛ch (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). - p xe v嘆i-bu畛ng tr畛ng (tubo-ovarian abscess - TOA): ph畛c h畛p v嘆i- bu畛ng tr畛ng c坦 v叩ch dy, tng t動畛i m叩u 畛 v叩ch, h畛i 但m m畉t k鱈nh m畛. - D畛ch t炭i c湛ng. 30
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3. sacd viem phan phu.10.2017.vsum.medic.k23

  • 1. SIU M CH畉N ON VIM PH畉N PH畛 1 Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
  • 2. VIM NHI畛M VNG CH畉U (PELVIC INFLAMMATORY DISEASE PID) B畛nh l箪 vi棚m nhi畛m v湛ng ch畉u (pelvic inflammatory disease PID) g畉p kh叩 nhi畛u 畛 ph畛 n畛. B畛nh th動畛ng lan truy畛n qua 動畛ng t狸nh d畛c, l畉u c畉u (gonorrhea) v chlamydia l 2 t叩c nh但n th動畛ng g畉p. Nhi畛m tr湛ng th動畛ng i vo tr畛c ti畉p qua k棚nh c畛 v n畛i m畉c t畛 cung. 担i khi nhi畛m tr湛ng qua m畛t 畛 vi棚m nhi畛m k畉 c畉n. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
  • 3. Nhi畛m tr湛ng qua 動畛ng m叩u r畉t hi畉m g畉p v th動畛ng do lao (tuberculosis). T畛n th動董ng th動畛ng 畛 c畉 hai b棚n (tr畛 tr動畛ng h畛p lan truy畛n t畛 畛 nhi畛m tr湛ng k畉 c畉n). S畛 hi畛n di畛n c畛a v嘆ng tr叩nh thai lm tng nguy c董 vi棚m nhi畛m v湛ng ch畉u. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
  • 4. H畉u qu畉 l但u di c畛a b畛nh l箪 ny l t狸nh tr畉ng au v湛ng ch畉u m畉n t鱈nh (chronic pelvic pain), v担 sinh v tng nguy c董 thai l畉c ch畛. Vi棚m nhi畛m kh畛i 畉u 畛 c畛 TC, lan vo n畛i m畉c TC (endometritis), r畛i v嘆i tr畛ng (acute salpingitis) v cu畛i c湛ng l v湛ng bu畛ng tr畛ng hai b棚n v mng b畛ng. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
  • 5. V嘆i tr畛ng b狸nh th動畛ng di kho畉ng 10cm, c坦 動畛ng k鱈nh t畛 1-4mm, th動畛ng kh担ng th畉y tr棚n si棚u 但m, tr畛 khi c坦 d畛ch bao quanh.
  • 6. L但m sng: b畛nh nh但n th動畛ng au, s畛t, cng t畛c v湛ng ch畉u, ra m畛 但m 畉o. Si棚u 但m qua ng達 b畛ng th動畛ng kh坦 ch但n oan b畛nh l箪 ph畉n phu味. Si棚u 但m qua ng達 但m 畉o 坦ng vai tr嘆 quan tr畛ng trong ch但n oan b畛nh. Ta c坦 2 th畛 ch鱈nh: Th畛 c畉p t鱈nh. Th畛 m畉n t鱈nh. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p527-579
  • 7. VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 7
  • 9. VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c ph湛 n畛 t畉o thanh. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 9
  • 10. V嘆i tr畛ng b狸nh th動畛ng COGWHEEL SIGN SIGNE DE LA ROUE DENTEE Vi棚m c畉p t鱈nh 10
  • 11. C畉t d畛c theo voi tr畛ng: Day thanh voi tr畛ng hai b棚n. 11
  • 12. 12
  • 14. VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 14
  • 15. Hydrosalpinx v畛i cogwheel sign N. Perrot et al. Echographie Endovaginale-Doppler couleur en Gynecologie-Obstetrique. 5e 辿dition. 2004 The Netter Collection OF MEDICAL ILLUSTRATIONS. Reproductive System. 2011 by Saunders, an imprint of Elsevier Inc. 15
  • 16. VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). - Vi棚m bu畛ng tr畛ng (oophoritis): Bu畛ng tr畛ng to ra, c坦 nhi畛u nang nh畛 (c坦 th畛 l畉m v畛i bu畛ng tr畛ng a nang). - Th但m nhi畛m m畛 m畉c treo v湛ng h畉 v畛, quanh t畛 cung. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 16
  • 17. 17
  • 18. Acute PID Chronic PID Sub-acute PID The Netter Collection OF MEDICAL ILLUSTRATIONS. Reproductive System. 2011 by Saunders, an imprint of Elsevier Inc. 18
  • 19. VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong m畛 (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 19
  • 20. V嘆i tr畛ng b狸nh th動畛ng Vi棚m m畉n t鱈nh BEADS-ON-STRING SIGN SIGNE DES PERLES SUR UN FIL 20
  • 21. 21
  • 22. 22
  • 26. Fluid-pus level Pus with gas HYRDOSALPINX PYOSALPINX 26
  • 27. VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong d畛ch (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). - p xe v嘆i-bu畛ng tr畛ng (tubo-ovarian abscess - TOA): ph畛c h畛p v嘆i- bu畛ng tr畛ng c坦 v叩ch dy, tng t動畛i m叩u 畛 v叩ch, h畛i 但m m畉t k鱈nh m畛. - D畛ch t炭i c湛ng. 27
  • 28. Peter M. Doubilet et al. Atlas of ultrasound in obstetrics and gynecology. 2012 TOA 畛 hai b畛nh nh但n. 28
  • 29. VIM NHI畛M VNG CH畉U (th畛 c畉p t鱈nh) PID - Pelvic Inflammatory Disease, acute phase - Vi棚m n畛i m畉c t畛 cung (endometritis). - Thnh v嘆i tr畛ng dy 5mm, 畛 lat ct ngang ta co d畉u hi畛u b叩nh rng (cogwheel sign) do thanh voi tr畛ng cung cac n畉p ni棚m m畉c phu n棚 t畉o thanh. - C坦 th棚 b畉t 畉u c坦 畛 d畛ch tai voi (hydrosalpinx). - Vi棚m bu畛ng tr畛ng (oophoritis): Bu畛ng tr畛ng to ra, c坦 nhi畛u nang nh畛 (c坦 th畛 l畉m v畛i bu畛ng tr畛ng a nang). - Th但m nhi畛m m畛 m畉c treo v湛ng h畉 v畛, quanh t畛 cung. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 29
  • 30. VIM NHI畛M VNG CH畉U (th畛 m畉n t鱈nh) PID - Pelvic Inflammatory Disease, chronic phase - 畛 d畛ch ho畉c 畛 m畛 v嘆i tr畛ng (hydrosalpinx or pyosalpinx): + Lat ct ngang: nh畛ng n畛t 畛 vach (do c畉t ngang n畉p ni棚m m畉c) t畉o thanh d畉u hi畛u chu畛i h畉t (beads-on-string sign). + Lat ct do味c: voi tr畛ng dan ra, thanh m畛ng, bi畛u hi畛n la nh畛ng c畉u tr炭c h狸nh b畉u d畛c v畛i nh畛ng v叩ch ngn kh担ng hon ton. * Hydrosalpinx: d畛ch h畛i 但m tr畛ng. * Pyosalpinx: h畛i 但m m畉t k鱈nh m畛, 担i khi c坦 h狸nh 畉nh m畛c d畛ch-m畛 (fluid-pus level) ho畉c c坦 kh鱈 trong d畛ch (nh畛ng 畛m h畛i 但m dy v畛i b坦ng l動ng d董). - p xe v嘆i-bu畛ng tr畛ng (tubo-ovarian abscess - TOA): ph畛c h畛p v嘆i- bu畛ng tr畛ng c坦 v叩ch dy, tng t動畛i m叩u 畛 v叩ch, h畛i 但m m畉t k鱈nh m畛. - D畛ch t炭i c湛ng. 30