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COLLÈGE NATIONAL

DES GYNÉCOLOGUES ET OBSTÉTRICIENS FRANÇAIS

Président : Professeur B.HÉDON

Deuxième partie

Imagerie /

gynécologie médicale 38
ES

JOURNÉES NATIONALES

Paris, 2014

97
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INTRODUCTION

r6, 5RG6=@AA6>6?E, 56D, E649?:BF6D, 56, AC@4CR2E:@?, >R5:42=6>6?E

2DD:DER6, 1ÇsS2, 2, 6?EC2U?R, F?6, 2F8>6?E2E:@?, 56D, 6IA=@C2E:@?D, 5F

=2,3:@AD:6,E6DE:4F=2:C6:, FA, ., 56D, 4@FA=6D, 6E, :=, 4@?DE:EF6, =0F?:BF6, 42FD6, 52?D, DA, ., 56D, 42D: A9JD:BF6, 4@>A=6E, 2G64, ?@E2>>6?E, F?6, A2=A2E:@?, 6E, =2, >6DFC6, 56D

56D,5R7RC6?ED:,

?@E2>>6?E, F?6, R49@8C2A9:6, A2C, G@:6, 6?5@C64E2=6, 496K, =6D, A2E:6?ED

6I4CRE@:C6,19JA@DA6C>:62:,

r0R49@8C2A9:6, D4C@E2=6, 6DE, :?5:BFR6, 52?D, =6D, :?76CE:=:ERD, 50@C:8:?6

DR4CRE@:C6,@F,6I4CRE@:C6:,

BEC r/ ne

I. CADRES ÉTIOPATHOGÉNIQUES

A2C, F?6, 9JA@DA6C>:6, 15:>:?FE:@?, 5F, G@=F>6, 56, DA6C>62, G@:C6, F?6

II. RÉSULTATS DE L"IMAGERIE EN FONCTION DE

L"ÉTIOLOGIE

99

50@C49:E6, @F, 56, E@CD:@?, E6DE:4F=2:C6:, r6D, E6DE:4F=6D, D@?E, D@FG6?E, 9JA@,8

BED lérrorIyr1lnr m!905)5 5$515;'!151$!%#1

II.1.a. Testicules

56,=06==:AD@V56:

6?,56DD@FD,56,BA,>=,0C4,F1:

:?8F:?2FI,@F,52?D,=6,A6=G:D,1d:8FC6,C2:

2G64, 56D, :>286D, 6?, 32?56, :?EC2A2C6?49J>2E6FD6D4, 9JA@R49@8T?6D, 6E

i=, 6I:DE6, 502FEC6D, A6CEFC32E:@?D, 56, =0R49@DECF4EFC6, 5F, A2C6?49J>6 D@?E, 56D, A6E:ED, DA@ED, 9JA6CR49@8T?6D, 1B, Q, C, >>2, D2?D, 4W?6, 50@>3C6 A@DERC:6FC:, a==6D, 4@CC6DA@?56?E, Q, 56D, 42=4@DA9RC:E6D, 56D, EF36D, DR>:?:,8

7TC6D:,i=,6?,6I:DE6,D,DE256D,L,

L,8C256, B, L, BF6=BF6D, C2C6D, >:4C@=:E9:2D6D, 1O, BA, A2C, 492>AD

506IA=@C2E:@?2,N

BEE r/ ne m!9015 85 65 5 5 a0>*6'0!!5 !#60#-5 a'9*5 '0*!.95 $'%60%65 9%

0'%16096!'%5

eu5 %5 '9*5 '0'%#5 $'%60%65 9=5 616!9#15 %5 *'1!6!'% !%9!%#596 BEF lérrorIyr1lnr m!9015755655 5u!0'#!6!115616!9#!015%5'0*!5505p5+7,56

505ppp5+7,-

m!90155655 5

9$905616!9#!05+1$!%'$,5'9;065%5'0*!5#'01

/9%5 !#%5 /!%06!#!6-5 i'0*!5 $'5 D5 +,5 65 $'5 e'**#05 *9#15 +, C6496C496, 50F?, ?@5F=6, :?EC2E6DE:4F=2:C6, DFDA64E, 42C, @?, :8?@C6, 6?4@C6

A6>6?E,50F?6,EF>6FC,0D4,H4,BD4,BF1:,

-?6, 2DD@4:2E:@?, 7CRBF6?E6, 2G64, F?6, 9JA@76CE:=:ER, 6DE, R82=6>6?E =02=ERC2E:@?, 5F, DA6C>@8C2>>6, C6DE6, 5:D4FER6, 5F, 72:E, 56D, 2?ER4R56?ED

7CRBF6?ED,56,4CJAE@C49:5:6:

é0:=, 6DE, :?7RC:6FC, Q, F, >>4, F?6, DFCG6:==2?46, C2AAC@49R6, 2F, 5R3FE, A6FE

II.1.b. Cordon spermatique

DE2D6, 5F, D2?8, G6:?6FI, 2G64, C67=FI, 509@C>@?6D, DFCCR?2=:6??6D, G@:C6

EC@A9:4:ER,E6DE:4F=2:C6:

8C256D,L

56,.2=D2=G2,N

L8C256, iii, L, G2C:4@4T=6, G:D:3=6, 6E, A2=A23=6, D2?D, >2?MFGC6, 56 .2=D2=G2: BEG r/ ne U6A6?52?E4, =6D, =:>:E6D, 56, =06I2>6?, 4=:?:BF6, D@?E, C64@??F6D, 6E

A@FC,5RE64E6C,F?,C67=FI,?@?,A2=A23=6:

r6, Y@AA=6C, 4@F=6FC, 6DE, A=FD, 677:42464, 5RE64E2?E, JD, ., 56D, C67=FI

BF2?E:7:6C,=2,5FCR6,5F,C67=FI:

r6, EC2:E6>6?E, 50F?6, G2C:4@4T=6, A6FE, 72:C6, 2AA6=, Q, =2, 49:CFC8:6

1=:82EFC6, G6:?6FD62, @F, Q, =2, C25:@=@8:6, :?E6CG6?E:@??6==6, 1D4=RC@86>3@=:,8

D2E:@?2,0BB1:

BEH lérrorIyr1lnr m!9055 50!'#5951!%!!6!;5#'0155#5$%(9;055#1#;5+i' 99

42?2FI, R;24F=2E6FCD:, r6D, E6DE:4F=6D, D@?E, 4=:?:BF6>6?E, 6E, R49@,8C2A9:,8

BF6>6?E, ?@C>2FI:, r6FC, G@=F>6, 6DE, ?@C>2=, 4@?EC2:C6>6?E, 2FI, :?76C,8 @3DE24=6,0E1:,r6D,)+ +*+"*4,=6D,4W?6D,677RC6?ED4,=6D,EF36D,RA:5:5J>2:C6D A6FG6?E, 5@?4, AC6?5C6, F?, 2DA64E, 5:=2ER4, 4@?DRBF6?46, 56, =0@3DE24=6, Q

II.2.a. Malformation des voies séminales

C6ACRD6?E6, =2, 42FD6, =2, A=FD, 7CRBF6?E6, 16?EC6, F, 6E, BH, .2, 509JA@76CE:=:ER BEI r/ ne m!905 45 5 è6%6!11$%65 *0'=!$#5 /9%5 '16#5 +'0*!,5 5 !#66!'% egee"e l*% "#+3)# &% 3%"+# * %,/ 33)%+* almnoc r023D6?46, 4@?8R?:E2=6, 3:=2ERC2=6, 56D, 42?2FI, 5R7RC6?ED, 6DE, F?6

56D,56FI,42?2FI,5R7RC6?ED:,

RA:5:5J>6D, D@?E, ?@C>2=6>6?E, ACRD6?E6D, 42C, 6==6D, @?E, F?6, @C:8:?6 egee""e l 3%3*" ,%"#+3)# &% 3%"+# * %,/ 33)%+* alnoc ÉF2?5, =028R?RD:6, 6DE, F?:=2ERC2=64, @?, C6EC@FG6, F?6, >2=7@C>2E:@? BEJ lérrorIyr1lnr m!90535 5è$%!$%615*'16 !%6!9=5+'0*!,55#56655#/*!!>$ +3,565%'9#5*'16 !%#$$6'!059#5;5!#66!'%5/$'%65+3, BFA r/ ne m!9015&555655 5 %1!59%!#60#59-5t50!%5951651%65+&, >60'*!.95+&, m!9015 5 5 65 5 5 1%5 '%%!6#5 !#60#5 15 %9=5 0%615 +'5

0*!5;'!5%'06#,

BFB lérrorIyr1lnr

II.2.b. Infections de l"appareil génital

DFC, =06?D6>3=6, 56, =2, G@:6, DR>:?2=6, 6E, A6FG6?E, 6?EC2U?6C, 56D, DER?@D6D

42?2=2:C6D:,r6D,86C>6D,6?,42FD6,D@?E,2G2?E,E@FE,=6,n!#$0" +)!&$+"*

6E,=0)'#*$ ,)#0+",$:,r6,5:28?@DE:4,56,46CE:EF56,6DE,2AA@CER,A2C,=2

GRD:4F=6D, DR>:?2=6D, 1d:8FC6D, BA, 6E, BB2:, r2, AC@DE2E:E6, 49C@?:BF6, D6

502K@@DA6C>:6, 50@C:8:?6, 6I4CRE@:C6:, a==6, A6FE, SEC6, 50@C:8:?6, A@DE8

:?7=2>>2E@:C6:

32D, 6E, 56D, 42?2FI, 5R7RC6?ED, ACRD6?ED, Q, =2, A2=A2E:@?, 5F, D4C@EF>:, a?

R49@,8C2A9:64, 6==6, A6FE, D0244@>A28?6C, 50F?6, 5:=2E2E:@?, 56D, GRD:4F=6D

4@?DE2,E2E:@?D, R49@8C2A9:BF6D, 5@:G6?E, SEC6, 4@CCR=R6D, 2FI, 5@??R6D, 5F

DF;6E, ?@C>2=:, r0@3DECF4E:@?, 56D, 42?2FI, R;24F=2E6FCD, A6FE, ?0SEC6, BF6

5:>:,?FE:@?,5F,G@=F>6,56,DA6C>6:

II.2.c. Kyste du carrefour urogénital

i=, D028:E, 56, CRD:5FD, 6>3CJ@=@8:BF6D, 56D, 42?2FI, H@=77:6?D, @F R;24F=2E6FCD, 6E, A6FG6?E, 2:?D:, @3DECF6C, =6D, G@:6D, DR>:?2=6D, AC@7@?56D: r@CDBF0:=D, D@?E, 4@>AC6DD:7D4, :=D, 6?EC2U?6?E, F?6, 5:=2E2E:@?, 502>@?E, 6E ?@E2>>6?E, 56D, 42?2FI, R;24F=2E6FCD, 1d:8FC6D, BG, 6E, BH2:, r6D, A2E:6?ED ACRD6?E6?E, 2=@CD, F?6, 2K@@DA6C>:6, @F, F?6, @=:8@K@@DA6C>:6, 2G64, F?6

9JA@DA6C>:6:

egee"e 0*+* $3"%*

Kystes m¸llériens

i=, D028:E, 50F?6, 7@C>2E:@?, R5:2?6, C@?56, >R5:2?64 =0FCTEC6:, BFC r/ ne m!905 )@5 5 .9##15 !%6!9115 5 #5 ;1!9#5 1$!%#5 65 5 #/$*'9#

0%6!##5+'0*!5;'!5%'06#,

m!905))5 5pèu5'9*5=!#5

85560'*!55#5;1!9#51$!%#50'!65*'16

!%6!91 BFD lérrorIyr1lnr m!9015 )85 65 5 5 .9##15 5 *0'166!65 5 6>*5 5 #!!6!'%15 5 #5 ?'% *0!*0!.95+'0*!5;'!5%'06#, m!9015)75655 5x0'166!650$%!$%615%5>*'1!%#5

855#5?'%5*0!*5

BFE r/ ne m!9015)5655 5pèu5'9*5'0'%#5

85516%'15!16#515%9=5"9#6901

+),5;5!#66!'%515;1!9#151$!%#15+), m!9015 )5 5 65 5 5 i'0*!5 %'06#5 5 #!!6!'%15 15 %9=5 "95 BFF lérrorIyr1lnr m!9015)45655 5r>165$!%5$:##0!%5+)4,565<'#!%5+)4,5+'0*! ;'!5%'06#, m!905)35 5r>165$!%5+)3,5'$*011!5;5!#66!'%515;1!9#151$!%#1

Kystes de l"utricule

5:=2E2E:@?,56,=0FEC:4F=6:

=2, 32D6, AC@DE2E:BF6:, i=D, 4@>>F?:BF6?E, 2G64, =0FCTEC6, AC@DE2E:BF6, 6E

4@?E:6??6?E,56D,DA6C>2E@K@V56D:,

egee""e 0*+* ')$3"%* a&, .&#"%*c

2FI, 5RA6?D, 56D, 42?2FI, R;24F=2E6FCD4, 50@Y, =6FC, A@D:E:@?, 5:D4CTE6>6?E

A2C2>R5:2?6:, r6FC, 4@?E6?F, A6FE, SEC6, R49@8T?6, 2G64, F?, ?:G62F, 6?

C2AA@CE,2G64,=2,DE28?2E:@?,DA6C>2E:BF6:

CONCLUSION

=2, A2E9@=@8:6, 5F, EC24EFD, FC@8R?:E2=, 6DE, 4CF4:2=6, A@FC, RG2=F6C, =09JA@,8 =06I2>6?, 56, CR7RC6?46:, a==6D, D6C@?E, 4@>A=RER6D, 52?D, 46CE2:?D, 42D A@FC, 4@?7:C>6C, =2, ?2EFC6, 5:DE2=6, 50F?, @3DE24=6, @F, 6?, 42D, 56, >2=7@C,8 >2E:@?D,4@>A=6I6D: BFG r/ ne BFH lérrorIyr1lnr

0B1S2=2>6, ts,+ #eÇC:>2CJ, >2=6

:?76CE:=:EJ, 42FD65, 3J, 4@?86?:E2=, AC@DE2E:4, 4JDEL

D@?@8C2A9:4, 2?5, >28?6E:4, C6D@?2?46, :>28:?8

7 :?5:?8D:,-C@=,i?E,BJJINGB1B2LFI8GB: 0

C1,TCF?6C62F, r,+ #eé@?@8C2A9:4, 6G2=F,8

2

E:@?, @7, 9F>2?, >2=6, :?76CE:=:EJ:, n, È25:@=

CAAANIB1BC2LBGJD8HAB:

0D1,U2C>:8?2?:, r,+ #eY6E64E:@?, @7

:?76CE:=:EJ:,n,-C@=,CAAENBHC1D2LBAEF8H:

0E1,U@C?F5, d,+ #ei>28:?8, @7, @3DECF4E:G6

0F1,U@C?F5, d,+ #e-=EC2D@F?5, 7:?5:?8D, :?

>2=6, 9JA@76CE:=:EJ, 2?5, :>A@E6?46:, aFC, È25:@=

CAABNBB1BB2LCBCG8DG:

0G1,U@C?F5,d,+ #e.2C:4@46=6L,DEC2E68:6D,:?

5:28?@D:D, 2?5, EC62E>6?E:, aFC, È25:@=, BJJJNJ1D2L

FDG8EF:

0H1,Y6U2DEC@, Tn4, Ç6E6CD@?, SU4, U@DE23:=6

ÈS:, S, F8J62C, 7@==@HFA, DEF5J, @7, 2DJ>AE@>2E:4 >6?, H:E9, E6DE:4F=2C, >:4C@=:E9:2D:D:, n, -C@=

CAAINBHJ1E2L,BECA8DN,5:D4FDD:@?,BECD:

0I1,Y@?<@=, Èf:, i>28:?8, :?, >2=68724E@C

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