eMedicine Specialties > Clinical Procedures > Radiology

Ultrasonography, Pelvic: Differential Diagnoses & Workup

Author: Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine; Consulting Staff, Department of Emergency Medicine, Singing River Hospital System, Singing River Hospital, and Ocean Springs Hospital
Coauthor(s): Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Contributor Information and Disclosures

Updated: Jun 8, 2006

Workup

Imaging Studies

  • Transabdominal imaging uses a low frequency and is performed to view large fibroids and ovaries that are high in the pelvis and to determine the shape and size of the bladder, uterus, vagina, and cervix.
    • A full bladder provides a sonographic window for evaluation of the uterus and adnexa. A full bladder has a teardrop-shaped appearance on the longitudinal view and is rectangular on the transverse view.
    • The uterus (longitudinal orientation) is oval and more echogenic than the bladder. The endometrial stripe is an echogenic (bright) line in the central uterus.
    • The vagina is a hypoechoic tubular structure posterior to the bladder and caudal to the uterus. A vaginal stripe can be identified.
    • The cervix is seen on the transabdominal view.
    • The cul-de-sac is important, especially in the evaluation of patients at risk for ectopic pregnancy. A small amount of fluid can be seen in the middle of the menstrual cycle. Otherwise, the cul-de-sac is considered a potential space.
    • Ovaries may not be clearly identified on transabdominal images. Ovaries have a characteristic follicular appearance and may be in a variety of positions.
  • Endovaginal scanning uses a high-frequency transducer and provides high-quality images of the endometrium, myometrium, cul-de-sac, and ovaries.
    • The uterus usually is identified easily on endovaginal sonograms. In the normal position (longitudinal view), the fundus is located on the left side of the imaging screen, with the cervix on the right. The entire uterus may not be seen at one time or on one particular endovaginal view. The uterus is pear shaped on the longitudinal view and round on the transverse view.
    • The endometrial stripe is located within the central uterus; its thickness varies with the patient's menstrual cycle. The stripe is thin and less echogenic after menses but becomes thick and echogenic from ovulation to the secretory phase.
    • The ovaries usually are located posterior and lateral to the uterus and anterior to the internal iliac artery and vein. They usually are medial to the external iliac vessels. The iliac vessels provide an anatomic landmark for localization of the ovaries. The ovaries are not always identified on endovaginal sonograms. The typical follicular appearance of the ovaries aids in their identification; however, the follicles can be confused with vessels. Using the nonscanning hand, the ultrasonographer can place gentle pressure over the lower abdomen and this may help in moving the ovary into the ultrasound image.
  • Endovaginal color flow Doppler ultrasonography
    • Some ultrasound machines have endovaginal probes that are capable of color flow imaging. This feature usually is seen on more expensive machines. This capability is helpful in localizing vessels within the pelvis and in determining blood flow to the ovaries, as in ovarian torsion.
    • Use of color flow imaging in ectopic pregnancy has been documented.
  • When a large tumor or mass (nonfibroid) is found at pelvic ultrasonography, a CT scan may provide valuable information.

More on Ultrasonography, Pelvic

Overview: Ultrasonography, Pelvic
Differential Diagnoses & Workup: Ultrasonography, Pelvic
Treatment & Medication: Ultrasonography, Pelvic
Follow-up: Ultrasonography, Pelvic
Multimedia: Ultrasonography, Pelvic
References
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References

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Further Reading

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Keywords

endovaginal sonography, transabdominal sonography, echography, echo, pelvic sonography, endovaginal imaging, evaluation of bleeding in pregnancy, evaluation of pelvic pain, evaluation of pelvic mass, evaluation of pelvic infection, evaluation of abnormal uterine bleeding, evaluation of pelvic trauma

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Contributor Information and Disclosures

Author

Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine; Consulting Staff, Department of Emergency Medicine, Singing River Hospital System, Singing River Hospital, and Ocean Springs Hospital
Verena T Valley, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Christopher A Fly, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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