Radiologi Sistem Reproduksi Wanita
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SISTEM REPRODUKSI WANITA
Dr. Linda Supardi, Sp.Rad
Dr. Sophia Utami, Sp.Rad
Bagian Radiologi RS Sumber Waras
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RADIOLOGI OBSTETRI - GINEKOLOGI
Dulu (era < 1960): sinar X Lewat trimester IIIndikasi kuat
Sekarang: USG ~ terutama obstetri.
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Dulu: PELVIMETRI, untuk melihat:
CPD Letak/jumlah/abnormalitas janin Perkiraan letak plasenta? Kematian janin
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1. Bentuk pelvis normal.
2. Kelainan2 tulang yg menyempitkan rongga pelvis.
3. Pelvimetri: metode untuk menilai adanya CPD (Cephalo Pelvic Disproportion).
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Saat ini jarang dilakukan karena :USGHasil tidak selalu akurat
Dilakukan lewat trimester II dan atas indikasi kuat!
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PELVIMETRI
Foto lateral pelvis posisi tegak/erect:
A. Pintu Panggul Atas: Conjugata vera = 12,5 cm
B. Pintu Panggul Tengah: Diameter AP = 12,5 cm
C. Pintu Panggul Bawah: Ujung coccygeus – tuberositas
ischii = 7,5 cm
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Posisi AP – Supine: Diukur diameter rongga pelvis AP
dan ‘side to side’. Pelvis minor koreksi untuk efek
magnifikasi.
A. Pintu Panggul Atas: • Diameter transversa = 13 cm.
B. Pintu Panggul Tengah.
C. Pintu Panggul Bawah: • Diameter interspinarum = 10 cm.• Diameter intertuberosum = 10,5 cm.
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PELVIMETRI
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Kematian janin:
Spalding Sign Moulage Sutura tulang kepala
bertumpuk. Hyperflexia menggulung
seperti bola. Gas dalam pembuluh darah.
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KEMATIAN JANIN
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KEMATIAN JANIN
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BIDANG GINEKOLOGI
Fibroma Massa tumor rongga panggul
kalsifikasi/bercak-bercak. Dermoid ovarium
Perkapuran dinding tumor/tumor lusen (= fat), gigi-gigi.
Piosalping TBC Perkapuran2 di lokasi tuba.
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HISTEROSALPINGOGRAFI Indikasi saat ini:
• Infertilitas.
• Translokasi IUD.
• Perdarahan sedikit.
• Dilakukan pada hari ke 10-13 siklus.
Kontra Indikasi: Kehamilan. Perdarahan yang berlebihan. PID (Pelvic Inflammatory Disease).
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Kontras: Jodium Water Soluble Komplikasi pemeriksaan HSG:
Ringan (nyeri di panggul),
bisa sampai syok. HSG juga mempunyai efek terapi
dengan melepaskan perlengketan2 ringan.
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Indikasi: Infertilitas primer dan sekunder. Kelainan uterus–tuba–kanalis servikalis:
Mis: Kelainan kongenital uterus:
• Hipoplasi.• Uterus didelfis: duplikasi uterus,
serviks dan vagina.• Uterus bikornis/unikornis.
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Infeksi:• Salpingitis TBC: tuba seperti untaian
kalung mutiara.• Peritubal filling & adhesi2: bisa spill / tidak.• Hidrosalping: tuba lebar, adhesi distal,
spill (-).Neoplasma: mioma, polip.Translokasi IUD.
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HISTEROSALPINGOGRAM NORMAL
• Uterus : bayangan segitiga terbalik.
• Tuba : halus seperti benang, agak
lebar di ampula.
•Spill : tumpahan kontras di rongga
pelvis.
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HISTEROSALPINGOGRAM NORMAL
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HSG ABNORMAL
1. Kelainan cavum uteri:A. Kelainan kongenital:
• Hipoplasia• Uterus bikornus• Uterus arkuatus• Uterus didelfis
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KELAINAN KONGENITAL UTERUS
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KELAINAN KONGENITAL UTERUS
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B. Penonjolan sebagian mukosa cavum uteri:• Adenomiosis• Endometriosis
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C. Filling defect cavum uteri: Sinekia: jaringan sikatrik dalam
cavum uteri. Fibromioma Polip Chorio Ca
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D. Dinding cavum uteri yang ireguler:• Hiperplasia menopause• Endometritis• Ca
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2. Kelainan canalis cervicalis:
A. Dinding kanalis ireguler : servisitis
B. Elongasi dan penyempitan : fibrosis
C. Filling defect : polip
D. Distorsi : penekanan tumor
E. Dilatasi : cervical Ca
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3. Kelainan tuba
A. Obstruksi.
B. Peradangan:
pengisian kontras paratuba.
C. Obstruksi dengan pelebaran : hidrosalping.
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HIDROSALPING
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ULTRASONOGRAFI
Hampir bisa menggantikan pemeriksaan radiologi konvensional, kecuali HSG ~ untuk menilai patensi tuba.
Penilaian bidang obsgin: Tumor/infeksi/kelainan kongenital. Kehamilan normal/abnormal.
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GAMBARAN NORMAL
Uterus tidak hamil.Uterus hamil dini (mg 5/6).Kehamilan ganda - mg ke-14
mempunyai 2/lebih kantung amnion.Denyut jantung janin - ke † janin.Kematangan janin - ukuran panjang
ubun-ubun dari nodus janin.
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UTERUS NORMAL
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KEHAMILAN 5 MINGGU
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KEHAMILAN 6,5; 8, 10 DAN 12 MINGGU
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KEHAMILAN KEMBAR 2 DAN 3 DINI
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KEHAMILAN KEMBAR 2
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1 .Kelainan kehamilan dini
Missed abortion.Blighted ovum: kehamilan tanpa embrio,
denyut (-), kantung (+), janin (-).Abortus hidup: volume kantung tidak
sesuai/kecil.Mola hidatidosa: uterus besar, janin (-),
hipoekoik >, denyut (-).
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MOLA HIDATIDOSA
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Kehamilan ektopik:
Kantung di luar uterus, janin (+), denyut (+). Uterus membesar tetapi tidak mempunyai
kantung. Ruptur ~ kantung ~ cairan hematom.
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KEHAMILAN EKTOPIK
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KEHAMILAN EKTOPIK TERGANGGU
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2 .Kelainan trimester II dan III
** Ukuran Biparietal Tengkorak Janin & Umur Hamil.
IUGR diukur sirkumferensial abdomen & kepala : Ratio H/A.
IUFD.Polihidramnion jumlah cairan
bertambah banyak.
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Kelainan kongenital SSP: Un-ensefal, hidrosefalus, mikrosefal,
meningoensefalokel.BB janin.Kelainan plasenta:
Letak rendah Plasenta previa.
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BIDANG GINEKOLOGI
Massa intrapelvic: padat & kistik.Massa uterus/ovarium
bila besar sulit di DD/.Kista ovarium: - unilokuler
- multilokulerAbses, hidrosalping, endometriosis.IUD: - intrauterin
- ekstrauterin.Fungsi ovarium : - waktu ovulasi - pasien subfertil, HSG N
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MIOMA UTERI
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KISTA DERMOID OVARIUM
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HIDROSALPING
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SITE OF ECTOPIC PREGNANCY
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SEKIAN
TERIMA KASIH