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Pelvic ultrasound.

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Presentation on theme: "Pelvic ultrasound."— Presentation transcript:

1 Pelvic ultrasound

2 Case 35 yo G3P1, LMP “4 wks ago”, lower abdominal pain and “dizziness”
IUD in place R > L, sharp, subjective fever, nausea, dysuria, brown vaginal discharge

3 Differential diagnosis
Gastrointestinal Appendicitis IBD IBS Constipation Urinary tract Cystitis Pyelonephritis Nephrolithiasis Reproductive Ectopic pregnacy IUP PID TOA Ovarian cyst Hemorrhagic cyst Ovarian torsion Fibroids Endometriosis

4 ED Workup U preg neg U dip + LE, + Prot, + Blood Physical exam
Point-of-care ultrasound of the pelvis

5 Indications Acute lower abdominal or pelvic pain
Acute pelvic inflammatory disease Evaluation of pelvic or adnexal masses

6 Yes/No questions Is there a life or organ-threatening gynecologic emergency? Ovarian torsion Tubo - ovarian abscess Are there other gynecologic abnormalities? Ovarian cysts Fibroids Other

7 Technique Transabdominal Low frequency probe Bladder full
Overall view of pelvis Endovaginal High frequency Bladder empty Better resolution, finer details


9 Transabdominal Sagittal
Anterior Feet Head Posterior

10 Transabdominal Transverse
Anterior R L Posterior

11 Endovaginal - Sagittal
Feet Anterior Posterior Head

12 Endovaginal - Transverse
. Feet R L Head


14 Ovaries Right Ovary Left Ovary

15 Ovarian cysts Most common ovarian masses in non- pregnant
Thin-walled, unilocular anechoic spheres Hemorrhagic cysts have heterogenic internal echoes Physiologic <2.5 cm Follicular cm Corpus luteum cysts up to 13 cm






21 Fibroids Most common gynecologic tumor
May present with dysuria, dysmenorrhea, constipation or low back pain Discrete masses within uterine wall May be hyper or hypoechoic Shadowing



24 Pelvic inflammatory disease
Inflammation of tubal mucosa Lumen fills with pus then spills to cul de sac Pyosalpinx with blockage of fallopian tube Hydrosalpinx with thinning of walls and distention Erosion through the distended wall and purulent material spills into ovary Tubo - ovarian abscess when pus becomes walled off

25 Role of Bedside TransvaginalUltrasonography in the diagnosis of Tubo - ovarian Abscess in the ED J Emerg Med 2008 Jan 31 (Epub) Retrospective review of 20 patients with TOA H & P factors unreliable: PID hx 35%, 45% with CMT or Adnx tender, 5% fever Ultrasound abnormalities in most 70% complex adnx mass, 25% echogenic fluid 15% pyosalpinx

26 Pyosalpinx

27 Hydrosalpinx

28 Tubo - ovarian abscess

29 Other masses

30 Endometrial polyps

31 Ovarian masses

32 IUDs

33 Best practices - EBM ED endovaginal ultrasound in nonpregnant women with right lower quadrant pain. Tayal, et al. Am J Emerg Med 2008 Non-pregnant females presenting with RLQ Pelvic ultrasound performed looking for: enlarged ovary or uterus fluid in cul de sac tubal dilatation large cystic mass multitissue density la


35 Pitfalls Failing to provide adequate analgesia
Confusing uterine vasculature with follicles within the ovary Confusing large ovarian follicles with fallopian tubes Confusing ovarian cysts with hydrosalpinx

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