Advertisement

Gynecologic Ultrasound

  • Angela Bray CredittEmail author
  • Jordan Tozer
Chapter
  • 1.2k Downloads

Abstract

In outpatient clinics and, more specifically, within the emergency department, women frequently present for evaluation of pelvic complaints. Fortunately, with increasing knowledge and the advancement of ultrasound, a more thorough assessment can be completed without exposing patients to unnecessary radiation. Transvaginal ultrasound allows providers to obtain valuable information about pelvic organs to aid in the diagnostic discovery of a patient’s complaint such as acute pelvic pain or abnormal vaginal bleeding. To this point, in most cases, gynecologic problems are best imaged using ultrasound. This chapter will focus on performing a gynecologic ultrasound, basic pelvic anatomy, image acquisition using a transvaginal approach, and interpretation of pathology.

Keywords

Ovarian cyst Polycystic ovarian syndrome Ovarian torsion Tubo-ovarian abscess Intrauterine device Fibroids 

Supplementary material

Video 11.1

Long axis of uterus. Sagittal view of an anteverted uterus in long axis using transvaginal ultrasound. Note the midline bright white endometrial stripe (MP4 2328 kb)

Video 11.2

Pouch of Douglas. Pouch of Douglas is a potential space posterior to the uterus and anterior to the rectum. In this transvaginal sagittal view, note the small amount of fluid posterior to the uterus within the pouch of Douglas (MP4 2241 kb)

Video 11.3

Uterus in transverse. Transverse view of a uterus in short axis using transvaginal ultrasound. Note the bright white endometrial stripe within the uterus

Video 11.4

Normal ovary. When imaging in a transverse plane, identify each ovary to the right and left of the uterus. Here, a normal ovary is seen with several small follicular cysts visualized as small hypoechoic circles (MP4 2373 kb)

Video 11.5

Simple ovarian cyst. In a transverse plane, an ovary is seen on the left side of the screen with a small simple cyst containing anechoic fluid (MP4 703 kb)

Video 11.6

Complex ovarian cyst. Complex ovarian cyst containing fluid with varying echogenicity imaged in a transverse plane (MP4 2312 kb)

Video 11.7

Ovarian torsion. Large ovarian cyst almost obliterating the normal ovarian architecture in this female with sudden onset unilateral pelvic pain is highly concerning for ovarian torsion (MP4 1942 kb)

Video 11.8

Ovary with normal color Doppler. Normal sized ovary with normal color flow as seen in this transvaginal ultrasound using color Doppler (MP4 2299 kb)

Video 11.9

Ovary with reduced flow on color Doppler. Ovary with a large ovarian cyst a small amount of flow as seen on color Doppler, concerning for ovarian torsion (MP4 2080 kb)

Video 11.10

Tubo-ovarian abscess. Transvaginal ultrasound of the right adnexa in transverse plane demonstrating multiple varying sized complex cystic appearing structures consistent with tubo-ovarian abscess (MP4 2330 kb)

Video 11.11

IUD Placement. Transvaginal ultrasound of the uterus in a sagittal plane demonstrating an intrauterine pregnancy with an IUD in place. Note the echogenic IUD with posterior shadowing followed by a gestational sac containing a yolk sac and fetal pole (MP4 2449 kb)

Video 11.12

Uterine fibroid. Transvaginal ultrasound of the uterus in a sagittal plan showing a small uterine fibroid located in the myometrium posterior to the uterine stripe (MP4 2267 kb)

References

  1. 1.
    Fox JC, Lambert MJ. Chapter 16: Gynecologic concepts. In: Ma OJ, Mateer JR, Reardon RF, Joing SA, editors. Emergency ultrasound. 3rd ed. New York: McGraw-Hill Education; 2014. p. 455–78.Google Scholar
  2. 2.
    Pavlik EJ, DePriest PD, Gallion HH, Ueland FR, Reedy MB, Kryscio RJ, van Nagell Jr JR. Ovarian volume related to age. Gynecol Oncol. 2000; 77(3):410-412. http://www.sciencedirect.com/science/article/pii/S0090825800957834?via%3Dihub. Accessed 23 Apr 2017.
  3. 3.
    Damigos E, Johns J, Ross J. An update on the diagnosis and management of ovarian torsion. Obstet Gynaecol. 2012; 14(4):229-236. http://onlinelibrary.wiley.com/doi/10.1111/j.1744-4667.2012.00131.x/pdf. Accessed 18 Apr 2017.
  4. 4.
    Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. RadioGraphics. 2008; 28(5):1355-1368. http://pubs.rsna.org/doi/pdf/10.1148/rg.285075130. Accessed 18 Apr 2017.
  5. 5.
    Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion, accuracy and predictive factors. Am Inst Ultrasound Med. 2011; 30:1205-1210. http://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/1205.full.pdf. Accessed 18 Apr 2017.
  6. 6.
    Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasound in the diagnosis of tuboovarian abscess in the emergency department. J Emerg Med. 2008; 34:4429-433. http://www.sciencedirect.com/science/article/pii/S0736467907007627. Accessed 18 Apr 2017.
  7. 7.
    Lambert MJ & Villa M. Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. 2004; 22(3):683-696. http://www.sciencedirect.com/science/article/pii/S073386270400046X. Accessed 18 Apr 2017.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Emergency MedicineVirginia Commonwealth University Medical CenterRichmondUSA

Personalised recommendations