Postoperative ultrasound. Postoperative changes

Caesarean section is the most frequently performed abdominal operation, exceeding the frequency of appendectomy and hernia repair combined. Frequency increase caesarean section creates a new problem, as the number of women with an operated uterus increases, and a scar on the uterus in the future is often the only indication for a second operation. The issues of the optimal caesarean section rate are at the center of discussions among obstetricians and gynecologists, a significant increase in the frequency of operative delivery both abroad and in Russia has become a "worrisome problem", since the desire to solve all obstetric problems with the help of an operation turned out to be untenable. The frequency of caesarean section in MORIAH, which also includes patients with an operated uterus, was 23.7% in 2008 and 24.9% in 2009; in the Moscow region, this figure varies from 17.7 to 20.6% , while there is a tendency to increase the number of surgical deliveries in the Moscow region as a whole, which accordingly entails an increase in the number postoperative complications.

It is known that the risk of complications in the mother with abdominal delivery increases by 10-26 times. With urgent operations, the frequency of these complications reaches 18.9%, with planned ones - 4.2%. So far, the most common endometritis (from 17 to 40% of cases). If earlier endometritis after a planned caesarean section developed in 5-6% of cases, and after an emergency - in 22-85%, then the use of antibiotic prophylaxis made it possible to reduce these figures by 50-60%. Postpartum endomyometritis is the main cause of the formation of an inferior scar on the uterus. An important problem in the formation of a wealthy scar is the activity of tissue repair in the area of ​​the wound on the uterus. The course of healing processes is determined by a large number of factors, which include: the state of the macroorganism, the technique of surgical intervention, the suture material used, the duration of the operation and blood loss, and the course of the postoperative period. Endometritis and more severe complications are often hidden behind the following masking diagnoses: bleeding in the postpartum period, subinvolution of the uterus, lochio- and hematometra, etc. last years doctors are increasingly faced with the problem of insolvency of the scar on the uterus in the remote postoperative period and at the planning stage of the next pregnancy.

The purpose of the study was to predict pregnancy complications in women with a uterine scar after caesarean section.

Material and methods

35 patients with uterine scar failure, 4 patients in the first trimester of pregnancy, 31 at the stage of preconception preparation were examined. Average age postpartum patients was 29 years. The reason for going to the doctor was chronic pelvic pain; exacerbations" chronic inflammation appendages"; dysuric disorders; secondary infertility; pregnancy planning; confirmation of a previously diagnosed incompetent scar.

A caesarean section in the lower uterine segment was performed within 1 to 5 years prior to the study, both routinely and for emergency reasons. Six examined patients underwent a second caesarean section, 2 with excision of the first scar, 4 without excision of the area of ​​the former scar. Information about previous operations was obtained only from the words of the patients; statements about the indications for surgery, the features of the operation and the postoperative period were absent in most cases. Only with careful history taking and careful questioning could it be possible to identify the features of the course of the previous pregnancy and the postoperative period. The development of complications was facilitated by an "inflammatory" obstetric and gynecological history: 34.2% of patients had endometritis after childbirth; mastitis - 8.5%; wound infection - 23.5%; endometritis after abortion - 18.2%; erosion of the cervix - 22.8%; acute salpingo-oophoritis - 11.4%, chronic - 22.8% of patients; previous infertility in history occurred in 25.7% of puerperas; wearing an IUD prior to a real pregnancy - 5.7%.

An analysis of the history of childbirth, which is not available in all cases, made it possible to determine the presence of technical errors during the operation: the use of rough manual techniques for removing the head (11.2%), the use of a continuous suture for suturing the uterus (34.2%), the use of reactogenic material (11.2%). .2%), inadequate hemostasis (8.5%); the duration of the operation is more than 2 hours (5.7%), the presence of pathological blood loss (8.5%).

The features of the course and management of the postpartum period in patients were: a long period of subfebrile condition (85.7%); bowel dysfunction (14.2%); presence of urinary syndrome - episodes of frequent and/or painful urination (31.4%); presence of wound infection (17.1%); application various methods local sanitation of the uterus in 74.3% of puerperas (hysteroscopy, vacuum aspiration, curettage of the cavity, lavage); appointment in the postoperative period of massive infusion therapy and long-term or repeated courses of antibiotic therapy (85.7%).

All patients underwent transvaginal and transabdominal ultrasound, three-dimensional reconstruction. In some cases, hydrosonography and hysteroscopy were used to confirm the diagnosis.

Results and discussion

The following signs were considered as criteria for the consistency of the scar on the uterus in the late postoperative period:

• typical position of the scar (Fig. 1);
• the absence of deformations, "niches", areas of retraction from the side of the serous membrane and the uterine cavity;
• the thickness of the myometrium in the region of the lower uterine segment;
• absence of hematomas in the structure of the scar, connective tissue inclusions, liquid structures;
• visualization of ligatures in the myometrium, depending on the duration of the operation and the suture material used;
• adequate blood flow;
• condition of the vesicouterine fold, Douglas space, parametria.

Rice. one. Atypical position of the scar, heterogeneity of the structure.

In 4 observations in the first trimester of pregnancy, an inconsistent scar was detected. One patient had a corporal caesarean section and a Stark caesarean section. Failure was defined as a rupture of the corporal scar with prolapse of the fetal egg under the serous membrane of the uterus (2.8%). In 3 (8.6%) cases, a sharp thinning of the scar was detected with the preservation of the myometrium no more than 2 mm, retraction of the outer contour, retraction from the uterine cavity. Due to the high risk of obstetric complications, abortion and plasty of the lower uterine segment were performed in all cases (Fig. 2, 3).

Rice. 2. The perfect scar.

Rice. 3. Pregnancy 7 weeks. Two scars on the uterus, uterine rupture along the scar.

1 - an independent scar after a cesarean section according to Stark; 2 - rupture of the uterus, the fetal egg prolapses through the corporal scar.

Signs of insolvency of the scar outside of pregnancy were manifested in the form of deformation of the outer contour of the uterus in the lower segment and at the level of the isthmus (Fig. 4), retraction of the serous membrane (Fig. 5), sharp thinning of the myometrium (Fig. 6), the presence of a "niche" from the side of the cavity uterus or destructive changes in the scar zone with the formation of multiple cavities in the myometrium (Fig. 7, 8).

Rice. 5. Invalid scar. Cross section. Retraction of the vesicouterine fold.

Rice. 6. Partial failure of the scar. Thinning of the myometrium, connective tissue inclusions in the area of ​​the scar.

Rice. 7. Retrodeviation of the uterus. Tissue defect in the area of ​​the scar (1).

Rice. eight. Incompetent scar after three caesarean sections. Liquid inclusions in the lower segment. Myometrium is not defined.

In 3 (8.57%) cases, the reason for visiting a doctor was dysuric manifestations, the patients were observed and treated by a urologist for several years after the previous operation. Echography revealed inconsistency of the scar on the uterus, a pronounced adhesive process between the uterus and bladder, endometriosis Bladder. Surgical treatment was performed: in 2 cases - by laparoscopic access, in 1 case - laparotomy with excision of the endometrioid infiltrate, plasty of the lower uterine segment (Fig. 9, 10).

Rice. 9. Incompetent scar, myometrium in the area of ​​the scar is not defined, endometriosis of the bladder.

1 - cervix; 2 - scar defect, endometriosis.

Rice. ten. Two scars on the uterus, endometriosis of the vesicouterine fold. Arrows indicate a myometrial defect replaced by an endometrial infiltrate.

Diagnosis of an incompetent scar on the uterus is always difficult, especially at the stage of pregnancy planning or in early dates already occurring pregnancy. Typically, neither patients nor clinicians are prepared to accept a diagnosis based on a single ultrasound examination. Verification of the diagnosis is carried out in all cases during a consultative examination, planning surgical treatment- using hydrosonography and hysteroscopy.

The presence of a "niche" from the side of the cavity in all cases was confirmed by hysteroscopy. In 16 cases, the insolvency of the scar was confirmed and surgical treatment was performed - excision of the scar and plasty of the lower segment during laparotomy or laparoscopic access. Seam failure, reoperation, generalization of the process were not noted in any case. menstrual function recovered in all patients. Pregnancy later occurred in 7 patients, all of them reported pregnancy and were promptly delivered live children. The remaining 22 patients refused pregnancy planning at this stage due to the high risk.

Considering the young age of the majority of patients, paraphrasing somewhat, we can unconditionally agree with the opinion of Ya.P. Solsky that "... in terms of its socio-demographic consequences, an unfavorable or disabling outcome of an obstetric complication is much more significant than the outcome of a complication of another etiology."

It must be admitted that in the short term we should not expect a decrease in the number of postoperative complications. This is due not only to an increase in the number of patients with immunopathology and extragenital pathology (obesity, diabetes), but also with a significant increase in operational activity in . We are talking, in particular, about a significant increase in the number of abdominal births.

We believe that the identification of the main causes of the formation of an incompetent suture on the uterus after cesarean section and the early implementation of modern diagnostic and surgical measures will improve the reproductive prognosis in patients with severe postpartum complications and realize the childbearing function even in the most difficult clinical situations.

Literature

1. Kovganko P.A. Caesarean section operation - past and present (http://www.noviyegrani.com/archives/title/343).

Hello Dear Timur Tokhirovich! Please tell me my situation is this. 06/04/2013 I had a fibroadenoma of the left breast removed (sectoral resection). Conclusion: FKM. In December 2013 was at the doctor's office who operated, said everything was normal after examining palpation. May 28, 2014 Has made US: In a lion. m / f at 1-2 hours closer to the periphery, an oval-shaped hypoechoic formation is visualized, horizontally oriented, with even clear contours, dimensions 10x6mm. homogeneous structure, with CDI avascular, a similar formation 6 mm in size is visualized nearby. 2 o'clock closer to the areola, along the upper edge postoperative scar a hypoechoic formation is visualized with dimensions of 12x8 mm, without clear contours, vertically oriented, avascular in CDI, an acoustic shadow comes from the formation. Conclusion: Focal formation of the left m/f in the area of ​​the p/o scar - postoperative fibrotic changes? Suspicion of malignancy. Signs of dyshormonal changes in the m/f due to the fibrous component, against the background of incomplete fatty involution of the mammary glands. Condition after surgical treatment of the mammary gland. Signs of benign formations of the left mammary gland (cysts with dense contents?, small fibroadenomas?. They sent me to an oncologist - a mammologist, she said that a biopsy should be done. Doctor, I'm just at a loss, only 04/01/2014. underwent laparoscopy to remove the ovarian cyst.But before the removal of the ovarian cyst, she drank Yarina for 3 months, the gynecologist prescribed it, she asked the mammologist for permission to take hormones, she said there were no contraindications. arrived on 10/15/2014. MMG; In the area of ​​postoperative changes, there was a definite nodular formation with fuzzy contours and the presence of multiple grouped microcalcifications. Visualization of a single axillary node on the right. 2 o'clock visible hypoechoic image with a clear, even contour measuring 13x6 mm horizontally, On the left at 3 o'clock in the scar zone, a hypoechoic rounded image 16mm blurred fuzzy contours with echoes, vertically directed. Conclusion:dis hormonal changes m/f due to the fibrous component, on the background of complete fatty involution of the mammary glands. benign formations of the left m/f at 2 o'clock. LMJ formation at 3 o'clock in the scar zone (ZNO?). Doctor, I'm DESPERATE. It turns out that this year’s May ultrasound and today’s one are the same (bad), 4 months have been lost, because in May they didn’t even do a trephine - a biopsy, but only a puncture. Now they did a biopsy of the lung formation at 15 hours, I’m waiting for an answer and I suffer a lot. My doctor is a surgeon-oncologist-mammologist, ktr. I had surgery in 2013. concerning f/adenoma does not agree with zakl. Ultrasound and MMG and says that this is nodular fibroadenomatosis against the background of postoperative changes, I don’t know what to think. Doctor, please tell me your opinion, I beg you. I am 41. I WILL LOOK FORWARD TO YOUR ANSWER!!!

Answers the question: Agishev Timur Tohirovich

Good afternoon, Timur Tokhirovich. I am 53 years old. April 1, 2014: - T4M1N1 breast cancer with disintegration and ulceration of the skin was diagnosed, puncture - moderately differentiated cancer. Right breast tumor = 63 * 51 * 43 by ultrasound. - CT - multiple mts in both lungs, pleura, in the mediastinal LU (merged into a single conglomerate), in the roots of the lungs, the size of the breast tumor is 58*52*54. May 2014: Core biopsy - infiltrative nonspecific cancer without reliable signs of invasion, grade 2 malignancy. IHC- ER/PR=210/280 HER2=1+ ki67=7%, hormone-dependent. June 2014 scintigraphy - purely ultrasound - in the liver a single metastasis of 2.5 cm July 1, 2014 HT was prescribed - tamoxifen 20 mg September 22, 2014 - CT-mts in the lungs, pleura, mediastinal LU - the picture did not change, the size of the tumor too. - Ultrasound - in the liver - a hemangioma of 8 mm, the metastasis has evaporated somewhere ("was there a boy?") ... - Continue HT therapy, follow-up examination after 3 months. Chemistry and Surgery are not offered to me, arguing that the tumor does not increase, stabilization, and chemistry can provoke bleeding from the wound. Disability is also not offered, although I have been observed at the oncology dispensary for six months. The ulcer on the chest gradually grows (in March, the diameter is about 2.5 cm, in October - 2.5 * 4.0) and overgrown with small bumpy formations. Bleeding at times purulent discharge No, but there is a specific smell. I work at the office at the computer, but I still need to get to the office by metro, constant shortness of breath with little physical activity: several steps up, 2 kg of weight to convey the problem - I suffocate. I can't grate carrots with my right hand. Around the joint thumb on the right hand constant swelling, swelling sometimes more, sometimes less. Questions: 1. Are Mts in the lungs unambiguously determined by CT data? or m.b. similar to another lung disease? sarcoidosis? bronchoadenitis? the pulmonologist finds it difficult to make a diagnosis based on the CT picture (14 years ago, after pneumonia, I always suffer from bronchitis + bronchial asthma mixed type) 2. Do I myself have to get a referral from the local oncologist to the commission for disability? Or do they offer it only to bedridden patients? 3. Should I expect surgery and/or chemotherapy? Or is it better to quit your job so as not to suffer and live as God wills? (I'm not afraid to die) Thank you in advance for your answer, your activity is highly respected.

Answers the question: Agishev Timur Tohirovich

Dear Timur Tokhirovich! My mother is 78 years old. Breast cancer T4N3M1 mts in the liver. She completed 3 cycles of chemotherapy. Treatment palliative x/t abitaxeli 210 mg intravenous drip. She has a very strong discharge with blood. Tell me how and what to properly handle the chest. We wash with furatsilin, cauterize with potassium permanganate and lubricate with Olazol. Tell me if there are any other drugs so that these opening mts live better. Thank you in advance for your response.

Answers the question: Agishev Timur Tohirovich

Any surgical intervention is a great test for the patient's body. This is due to the fact that all its organs and systems are under increased stress, no matter if the operation is small or large. Especially "gets" the skin, blood, and if the operation is performed under anesthesia, then the heart. Sometimes, after everything seems to be over, a person is diagnosed with a “seroma of the postoperative suture”. What it is, most patients do not know, so many are afraid of unfamiliar terms. In fact, seroma is not as dangerous as, for example, sepsis, although it also does not bring anything good with it. Consider how it turns out, what is dangerous and how it should be treated.

What is it - postoperative suture seroma

We all know that many surgeons perform “miracles” in the operating room, literally bringing a person back from the other world. But, unfortunately, not all doctors conscientiously perform their actions during the operation. There are cases when they forget cotton swabs in the patient's body, do not fully ensure sterility. As a result, in the operated person, the suture becomes inflamed, begins to fester or diverge.

However, there are situations when problems with a suture have nothing to do with the negligence of doctors. That is, even if 100% sterility is observed during the operation, the patient in the incision area suddenly accumulates a liquid that looks like an ichor, or pus of a not very thick consistency. In such cases, one speaks of a seroma of the postoperative suture. What it is, in a nutshell, we can say this: it is education in subcutaneous tissue cavity in which serous effusion accumulates. Its consistency can vary from liquid to viscous, the color is usually straw yellow, sometimes supplemented with blood streaks.

At-risk groups

Theoretically, a seroma can occur after any violation of the integrity of the lymphatic vessels, which do not “know how” to quickly thrombose, as blood vessels do. While they are healing, lymph moves through them for some time, flowing from the places of ruptures into the resulting cavity. According to the ICD 10 classification system, the seroma of the postoperative suture does not have a separate code. It is put down depending on the type of operation performed and on the cause that influenced the development of this complication. In practice, it most often happens after such cardinal surgical interventions:

• abdominal plastic;
• caesarean section (for this seroma of the postoperative suture, ICD code 10 “O 86.0”, which means suppuration of the postoperative wound and / or infiltrate in its area);
• mastectomy.

As you can see, the risk group is mainly women, and those of them who have solid subcutaneous fat deposits. Why is that? Because these deposits, when their integral structure is damaged, tend to flake off from the muscle layer. As a result, subcutaneous cavities are formed, in which fluid begins to collect from the lymphatic vessels torn during the operation.

The following patients are also at risk:

• suffering from diabetes;
• aged people (especially overweight);
• hypertension.

The reasons

To better understand what it is - postoperative suture seroma, you need to know why it is formed. The main causes do not depend on the competence of the surgeon, but are a consequence of the body's reaction to surgical intervention. Those reasons are:

1. Fat deposits. This has already been mentioned, but we add that in overly obese people whose body fat is 50 mm or more, seroma appears in almost 100% of cases. Therefore, doctors, if the patient has time, recommend performing liposuction before the main operation.
2. Large area of ​​the wound surface. In such cases, too many lymphatic vessels are damaged, which, accordingly, release a lot of fluid, and heal longer.

Increased tissue trauma

It was mentioned above that the seroma of the postoperative suture depends little on the conscientiousness of the surgeon. But this complication directly depends on the skills of the surgeon and the quality of his surgical instruments. The reason why a seroma can occur is very simple: the work with tissues was too traumatic.

What does it mean? An experienced surgeon, performing an operation, works delicately with damaged tissues, does not squeeze them unnecessarily with tweezers or clamps, does not lack, does not twist, the incision is made quickly, in one precise movement. Of course, such jewelry work largely depends on the quality of the instrument. An inexperienced surgeon can create the so-called vinaigrette effect on the wound surface, which unnecessarily injures the tissues. In such cases, the postoperative suture seroma code ICD 10 can be assigned as follows: "T 80". It means "complication surgical intervention, not noted in other headings of the classification system.

Excessive electrocoagulation

This is another reason that causes a gray suture after surgery and to some extent depends on the competence of the doctor. What is coagulation in medical practice? This is a surgical intervention not with a classic scalpel, but with a special coagulator that produces a high-frequency electric current. In fact, this is a point cauterization of blood vessels and / or cells with a current. Coagulation is most often used in cosmetology. She excels in surgery as well. But if it is performed by a physician without experience, he may incorrectly calculate the required amount of current strength or burn excess tissue with them. In this case, they undergo necrosis, and neighboring tissues become inflamed with the formation of exudate. In these cases, the seroma of the postoperative suture in ICD 10 is also assigned the code "T 80", but in practice such complications are recorded very rarely.

Clinical manifestations of seroma of small sutures

If the surgical intervention was on a small area of ​​\u200b\u200bthe skin, and the suture turned out to be small (respectively, the traumatic manipulations of the doctor affected a small amount of tissue), the seroma, as a rule, does not manifest itself. In medical practice, there are cases when patients did not even suspect about it, but such a formation was discovered during instrumental research. Only in isolated cases does a small seroma cause slight pain.

How to treat it and should it be done? The decision is made by the attending physician. If he deems it necessary, he can prescribe anti-inflammatory and pain medications. Also, for a faster doctor may prescribe a number of physiotherapy procedures.

Clinical manifestations of seroma of large sutures

If the surgical intervention affected a large volume of the patient's tissues or the suture turned out to be too large (the wound surface is extensive), the occurrence of seroma in patients is accompanied by a number of unpleasant sensations:

• redness skin in the area of ​​the seam;
• pulling pains, aggravated in the standing position;
• during operations in the abdominal region, pain in the lower abdomen;
• swelling, bulging of the abdomen;
• temperature rise.

In addition, suppuration of both large and small seroma of the postoperative suture may occur. Treatment in such cases is carried out very seriously, up to surgical intervention.

Diagnostics

We have already examined why a seroma of a postoperative suture may occur and what it is. The methods of treating seroma, which we will discuss below, largely depend on the stage of its development. In order not to start the process, this complication must be detected in time, which is especially important if it does not declare itself in any way. Diagnostics is carried out by such methods:

Examination by the attending physician. After the operation, the doctor is obliged to examine the wound of his patient daily. If undesirable skin reactions (redness, swelling, suppuration of the suture) are detected, palpation is performed. If there is a seroma, the doctor should feel fluctuation (flow of liquid substrate) under the fingers.

ultrasound. This analysis perfectly shows whether or not there is fluid accumulation in the seam area.

In rare cases, a puncture is taken from the seroma to clarify the qualitative composition of the exudate and decide on further actions.

Conservative treatment

This type of therapy is practiced most often. In this case, patients are assigned:

• antibiotics (to prevent possible further suppuration);
• anti-inflammatory drugs (they relieve inflammation of the skin around the suture and reduce the amount of fluid released into the formed subcutaneous cavity).

More often appointed nonsteroidal drugs such as Naproxen, Ketoprofen, Meloxicam.

In some cases, the doctor may prescribe anti-inflammatory steroids, such as Kenalog, Diprospan, which block inflammation as much as possible and accelerate healing.

Surgery

According to the indications, including the size of the seroma and the nature of its manifestation, surgical treatment can be prescribed. It includes:

1. Punctures. In this case, the doctor removes the contents of the resulting cavity with a syringe. The positive aspects of such manipulations are as follows:

• can be performed on an outpatient basis;
• painless procedure.

The disadvantage is that you will have to do a puncture more than once, and not even two, but up to 7 times. In some cases, it is necessary to perform up to 15 punctures before the tissue structure is restored.

2. Installation of drainage. This method is used for seromas that are too large in area. When setting up a drain, patients are given antibiotics in parallel.

Folk remedies

It is important to know that, regardless of the reasons for which the seroma of the postoperative suture has arisen, this complication is not treated with folk remedies.

But at home, you can perform a number of actions that promote the healing of the seam and are the prevention of suppuration. These include:

• lubrication of the seam with antiseptic agents that do not contain alcohol ("Fukortsin", "Betadine");
• application of ointments ("Levosin", "Vulnuzan", "Kontraktubeks" and others);
• inclusion in the diet of vitamins.

If suppuration has appeared in the seam area, it is necessary to treat it with antiseptic and alcohol-containing agents, for example, iodine. In addition, antibiotics and anti-inflammatory drugs are prescribed in these cases.

Traditional medicine recommends making compresses with alcohol tincture live cost. Only the roots of this herb are suitable for its preparation. They are well washed from the ground, crushed in a meat grinder, put in a jar and poured with vodka. The tincture is ready for use in 15 days. For a compress, you need to dilute it with water 1: 1 so that the skin does not burn.

For wound healing and surgery there are many folk remedies. Among them are sea buckthorn oil, rosehip oil, mummy, beeswax, melted together with olive oil. These funds must be applied to gauze and applied to the scar or seam.

Seroma of the postoperative suture after caesarean section

Complications in women who delivered by caesarean section are common. One of the reasons for this phenomenon is the body of a woman in labor, weakened by pregnancy, unable to provide rapid regeneration of damaged tissues. In addition to seroma, there may be ligature fistula or a keloid scar, and in the worst case, suppuration of the suture or sepsis. Seroma in women in labor after cesarean section is characterized by the fact that a small dense ball appears on the seam with exudate (lymph) inside. The reason for this is the damaged vessels at the incision site. As a rule, it does not cause anxiety. Seroma postoperative suture after cesarean does not require treatment.

The only thing a woman can do at home is to treat the scar with rosehip or sea buckthorn oil to heal it as soon as possible.

Complications

The seroma of the postoperative suture does not always and not all pass by itself. In many cases, without a course of therapy, it is able to fester. This complication can be caused chronic diseases(for example, tonsillitis or sinusitis), in which pathogenic microorganisms penetrate through the lymphatic vessels into the cavity formed after the operation. And the liquid that collects there is an ideal substrate for their reproduction.

Another unpleasant consequence of seroma, which was not paid attention to, is that it does not fuse with muscle tissues, that is, the cavity is constantly present. This leads to abnormal mobility of the skin, to tissue deformation. In such cases, it is necessary to apply repeated surgical intervention.

Prevention

On the part of the medical staff, preventive measures consist in the exact observance of the surgical rules for the operation. Doctors try to perform electrocoagulation sparingly, injuring tissues less.

On the part of patients, preventive measures should be as follows:

1. Do not agree to an operation (unless there is an urgent need for it) until the thickness of the subcutaneous fat reaches 50 mm or more. This means that first you need to do liposuction, and after 3 months to carry out the operation.
2. After surgery, wear high-quality compression stockings.
3. At least 3 weeks after the operation, exclude physical activity.

The problem of neoplasms in the mammary gland can affect any woman at any age, regardless of her social status. In order to detect breast disease in time, it is very important to start the diagnosis in time. A hypoechoic neoplasm means that its structure does not differ from that of the tissue. Usually, such an ultrasound conclusion suggests that an additional study is needed to clarify the diagnosis.

Features of hypoechoic formation

In most cases, types of breast cancer are. The echostructure of the tumor is different and depends on many factors: the presence of areas of necrosis, fibrosis, calcifications, and so on.

You need to know that this is not yet the final diagnosis, but only a description of the structure of the neoplasm.

It only shows up. During this procedure, the ultrasonic sensor generates high-frequency sound vibrations. The device also picks up reflected signals.

The evaluation of the ultrasound waves coming from the transducer is very subjective. It depends on many factors:

• wave frequencies;
• some anatomical features person;
• doctor's qualification level;
• completeness of information about the signs of a particular disease in a patient.

The hypoechogenicity of an object in the mammary gland depends on the acoustic density of its tissue. In the picture, it will look like an area with dark color. In this area, high-frequency sound travels much more slowly than in any other space. These characteristics most often have an object filled with liquid.

What does it mean if a deviation is found in the mammary gland



The presence of a hypoechoic formation on the image indicates such diseases.

• breast carcinoma. It has fuzzy contours, as well as an acoustic shadow. In addition, it is uneven in its structure.
• Adenosis. This pathology has similar signs - fuzzy boundaries and hypoallergenicity.
• Typical cyst. She has reduced echogenicity. A typical cyst has regular and clear contours.
• Atypical cyst has very thick walls. There is noticeable growth inside.
• the presence of clear and even contours. It looks like a malignant object with slow growth.



Diagnosis of the mammary glands also helps to detect. With the help of ultrasound, the presence of painful phenomena in the mammary gland, hypoechoic rims, etc. is determined.

What pathologies does this education speak of?

The presence of a hypoechoic object in the mammary gland causes. Tumors that give a stellate appearance of the pattern have a scirrhous type of structure. One or more areas of fibrous tissue are visualized in the center of the tumor. On the periphery of such tissue are areas of tumor cells formed from epithelial tissue. Breast ultrasound can detect infiltrative ductal cancer.



Hypoechoic content is also characteristic of medullary and colloidal cancerous tumors. Medullary carcinoma is round or lobular in shape. The lobules are very clearly demarcated from each other and do not have a capsule inside. With the growth of such a tumor, dead areas with a lack of echogenicity are found.

Sometimes anechoic areas may indicate the presence of an active growth zone in the mammary gland. malignant tumor. These cancers are rarely seen after menopause.

Colloidal cancer grows very slowly. Its cells produce a large number of mucous secretion. Colloidal formation in the mammary gland is characterized by reduced echogenicity.

Intracavitary cancer is also quite rare. Cavitary hypoechoic formation with thickened walls and growths often occurs in elderly patients. The difficulty of diagnosis lies in the fact that they are not easy to differentiate from benign formations.

Hypoechoic structures in the mammary gland also indicate the development of an edematous-infiltrative form. malignant neoplasm. Clinically, this cancer is characterized by redness as well as thickening of the skin. In some cases, it becomes like a lemon peel. The image shows a thickening of the skin, an increase in the echogenic ability of fatty tissue, as well as the presence of hypoechoic tubular structures.

With metastases to the mammary gland, a hypoechoic formation with a heterogeneous structure is visualized. Its shape is round, has definable contours. Metastases can also be located in the area under the skin.

Echogenicity of benign tumors

Among all benign tumors, the most common. It is usually formed as a result of abnormal development of the gland. Fibroadenomas can vary in size. Occasionally - no more than 20 percent of cases, they are multiple.

Sonographically, this is a formation with clear and even edges. Squeezing the fibroadenoma with a sensor leads to a slipping effect, that is, the tumor is displaced in the surrounding tissues. If the size of the tumor is less than one centimeter in diameter, such a formation has the correct structure and shape. The larger the fibroadenoma, the more often its hypoechoic rim is found. In one of four cases, microcalcifications are visualized.

Fibroadenoma more than 6 cm in diameter is giant. It is characterized by the severity of the acoustic shadow. Hypoechoic fibroadenoma is usually poorly defined if the mammary gland has a lot of adipose tissue.



Phylloid tumor is very rare. In one out of ten cases, it can degenerate into a sarcoma. The benignity or malignancy of such a tumor can only be determined histologically.

The ultrasound picture of the lipoma is also hypoechoic and homogeneous. In the presence of hyperechoic inclusions in it, a rim is sometimes released. Sometimes it can be quite difficult to determine on ultrasound due to the high content of adipose tissue in the mammary gland.

Further diagnosis of the breast



As already mentioned, the presence of a hypoechoic formation in the mammary gland is an indication for further diagnosis in order to clarify the diagnosis. So, detects newly formed tumor structures.

As well as power Doppler sonography are highly informative types of studies. Thanks to them, a much larger number of tumor formations can be detected.

In addition, the following methods are used to diagnose the breast:

• biopsy of breast tissue;
• CT scan;
• magnetic resonance imaging;
• mammoscintigraphy.



Mammography breast cancer

Women need to remember that after reaching the age of forty, all women need to have regular mammograms. Computed and magnetic resonance imaging provide the most accurate diagnostic results.

Mammoscintigraphy is one of the newest types of breast examination. The doctor determines the nature of cancer in the gland with the help of radioactive substances. Women do not need to be afraid of the use of such substances, as they are harmless.

And of course, every woman should pay Special attention breast self-examination. In most cases, women go to the doctor, having already noticed a suspicious neoplasm.

Conclusion

Hypoechoic formation of the mammary glands does not yet indicate the malignancy of the process. However, it can be a sign of many diseases. Only a comprehensive diagnosis can accurately determine the disease.
Women should not be afraid of further diagnostic measures after an ultrasound examination. In most cases, they contribute to the correct diagnosis and the appointment of effective treatment.

Or another pathological lesion. Regardless of size, any focal formation of the mammary gland must be diagnosed in a timely manner, until the disease has caused dangerous complications in the patient.

Focal formation of the mammary gland: what is it

Focal formations of the mammary glands on ultrasound are a local monotumor, which can be single or multiple. It is able to have both clear and blurry contours.

Most often, such seals in the breast are benign and do not pose an oncological risk, however, if they are large, they can compress the tissues, thereby impairing blood circulation. That is why it is important to treat them promptly.

Any woman can have such an education, regardless of age. Despite this, doctors note that stress, hormonal changes and bad habits significantly increase the risk of breast tumors.

ICD-10 code

AT international classification diseases focal formation of the right or left mammary gland (benign lesion) has the ICD code - D24.

The malignant tumor has the code C50.

It is important to know that it is the type of tumor that will determine all further tactics. medical therapy. Thus, if a woman may need only drug therapy, then to get rid of a malignant tumor, the patient will need to undergo long-term chemotherapy, hormone therapy and, if necessary, surgery.

Reasons for the development of pathology

The main reason for the development is called changes in the hormonal background. Additional factors for the appearance of such diseases are called:

Symptoms and anatomical difference from the norm

Photos of developing neoplasms in the breast can be viewed on medical portals. At the same time, physicians distinguish the following most frequent characteristics these pathologies:

Diagnostic Measures

At the first suspicion, a woman should contact an experienced mammologist. Traditional diagnostics in this case involves palpation of the mammary glands, anamnesis, and taking blood tests for hormones.

Ultrasound diagnostics is also mandatory. If malignancy is suspected, an MRI may be performed.

Instrumental research methods

Informative methods instrumental diagnostics mammary glands are:

1. Mammography. This is a type of x-ray examination with reduced radiation exposure. The procedure is prescribed when clinically necessary. It can show medium and large formations. Small foci.
2. MRI. It is used when cancer is suspected. This is a very informative and safe procedure that can examine the breast tissue in layers.

1. Biopsy. She is on a cancerous type of education.

Interpretation of ultrasound results

Ultrasound examination is today considered one of the most informative diagnostic methods, which is usually prescribed for women under 35 years of age. This procedure should be performed from 5 to 12 days menstrual cycle. So the study will be the most accurate.

The mammologist () is engaged in deciphering the results of the ultrasound. At the same time, the procedure will help to view the tissues of the mammary glands and their ducts, lymph nodes.

Treatment of the disease

Treatment of focal formation in the mammary gland in a woman, first of all, depends on the specific disease identified and the type of cells. With a cancerous lesion or large tumor of a benign type, the doctor will most likely suggest surgery (mastectomy, etc.). Also, a malignant formation requires mandatory chemotherapy and radiation therapy.

Conservative drug therapy involves the appointment of such drugs:

1. A drug Andriol. It contains the male hormone. A contraindication to treatment with such a remedy is the suspicion of carcinoma, as well as individual intolerance to the substance of the drug.
2. Means for blocking the increased activity of estrogens. For this, the patient may be prescribed drugs Tamofen, Valodex. Use them is contraindicated only during pregnancy.
3. With a shortage of progesterone, women are prescribed its synthetic analogues ( Duphaston).
4. To normalize the hormonal background, drugs of the prolactin group are used ( Ronalyn).

In addition, in order to reduce stress in a woman in a similar condition, she is recommended to take sedatives. It can be tablets or drops ( Novopassit).

In the event that the cause of the disease is problems with thyroid gland, a woman should take drugs with iodine ( Iodomarin).

To eliminate inflammation, NSAIDs (Diclofenac) are prescribed.

During the treatment period, the patient should adhere to a well-balanced, healthy eating, have a good rest. Equally important is the support of loved ones. This will help mentally tune in to fight the disease.

Useful video

What tumors can form in the chest is voiced by the doctor in this video.

Prevention

Despite the fact that the causes of breast tumors in women are not yet fully understood, the following doctor's recommendations can reduce the risk of their occurrence:

Forecast

The prognosis for focal formation in the breast in women is individual for each patient. It depends on the specific diagnosis, cause and degree of neglect of the disease. The timeliness of the treatment started is also important. In such a state, a woman should follow all medical recommendations.

In general, at benign tumor after the therapy, the prognosis is favorable. The main thing is not to start the course of the tumor.

Negative prognosis at malignant formation which has been launched. In this condition, the tumor will spread rapidly, so the chances of life are small.

Luckily, modern medicine can help defeat focal education. That is why women should be very attentive to their health and undergo preventive ultrasound examinations in time.