eMedicine Specialties > Clinical Procedures > Radiology

Ultrasonography, Pelvic

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

Introduction

Background

Pelvic sonography may be viewed as a form or extension of the physical examination. In transabdominal scanning, a full bladder is used to displace bowel gas and serve as an acoustic window to allow a large viewing field of the pelvis. Endovaginal imaging is the preferred technique for emergency physicians because a full bladder is not necessary. Filling the bladder delays the examination.

Clinical

History

Clinical indications for pelvic sonography include the following:

  • Evaluation of vaginal bleeding in early pregnancy
    • This indication is well outlined in Pregnancy, Ectopic.
    • Subchorionic hemorrhage (implantation bleeding) is a common cause of spotting.
    • Endovaginal scanning uses a high-frequency transducer and enables optimal imaging of organs close to the probe, including the endometrium, myometrium, cul-de-sac, and ovaries, which can be seen in detail.
  • Evaluation of pelvic pain
    • Ultrasonography can be used to evaluate pelvic pain, a common complaint of patients presenting to the ED, and entities such as ovarian cysts, tubo-ovarian abscesses, uterine fibroids, or even an infected pelvic kidney.
    • In a female patient who is obese, pelvic ultrasonography can simplify a difficult physical examination.
  • Evaluation of a pelvic mass
    • Pelvic ultrasonography can be used to determine the etiology of a pelvic mass.
    • Compared with endovaginal ultrasonography, transabdominal ultrasonography uses a lower frequency and can penetrate farther, with a large field of view. Thus, fibroids, ovaries, or cysts located high in the pelvis may be out of the focal range of an endovaginal probe. In addition, pelvic kidneys can be visualized.
  • Evaluation of pelvic infection
    • Tubo-ovarian abscesses are difficult to diagnose at physical examination.
    • A normal fallopian tube may not be visualized at endovaginal ultrasonography; however, a fluid- or pus-filled tube can be identified.
    • Pelvic inflammatory disease can be identified at ultrasonography.
  • Localization of an intrauterine device or foreign body
    • Ultrasonography can aid in the localization or detection of an intrauterine device or foreign body.
    • An intrauterine device produces a characteristic acoustic artifact (shadow), which is helpful to the physician sonographer.
  • Evaluation of trauma
    • Views of the pelvis are used at ultrasonographic examination to evaluate for free fluid or clotted blood, which can be present in the pouch of Douglas (cul-de-sac).
    • Views of the pelvis obtained before insertion of a Foley catheter are helpful.
  • Evaluation of abnormal uterine bleeding in the premenopausal patient as well as the postpartum and postabortion patient

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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  2. Brown DL. Pelvic ultrasound in the postabortion and postpartum patient. Ultrasound Q. Mar 2005;21(1):27-37. [Medline].

  3. Choi H, Blaivas M, Lambert MJ. Gestational outcome in patients with first-trimester pregnancy complications and ultrasound-confirmed live intrauterine pregnancy. Acad Emerg Med. Feb 2000;7(2):200-3. [Medline].

  4. Dart RG. Role of pelvic ultrasonography in evaluation of symptomatic first-trimester pregnancy. Ann Emerg Med. Mar 1999;33(3):310-20. [Medline].

  5. Deutchman M. Pelvic applications. In: Ultrasound in Emergency Medicine. 1995: 11.

  6. Dodson MG. Clinical uses. In: Transvaginal Ultrasound. Portland, Ore: Book News;1991: 1-18, 165-200.

  7. Garel L, Dubois J, Grignon A. US of the pediatric female pelvis: a clinical perspective. Radiographics. Nov-Dec 2001;21(6):1393-407. [Medline].

  8. Ignacio EA, Hill MC. Ultrasound of the acute female pelvis. Ultrasound Q. Jun 2003;19(2):86-98; quiz 108-10. [Medline].

  9. Lambert MJ, Villa M. Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. Aug 2004;22(3):683-96. [Medline].

  10. Morgan A. Adnexal mass evaluation in the emergency department. Emerg Med Clin North Am. Aug 2001;19(3):799-816. [Medline].

  11. Okaro E, Valentin L. The role of ultrasound in the management of women with acute and chronic pelvic pain. Best Pract Res Clin Obstet Gynaecol. Feb 2004;18(1):105-23. [Medline].

  12. Phelan MB, Valley VT, Mateer JR. Pelvic ultrasonography. Emerg Med Clin North Am. Nov 1997;15(4):789-824. [Medline].

  13. Quillin SP, Siegel MJ. Transabdominal color Doppler ultrasonography of the painful adolescent ovary. J Ultrasound Med. Jul 1994;13(7):549-55. [Medline].

  14. Stark JE, Siegel MJ. Ovarian torsion in prepubertal and pubertal girls: sonographic findings. AJR Am J Roentgenol. Dec 1994;163(6):1479-82. [Medline].

  15. Teisala K, Heinonen PK, Punnonen R. Transvaginal ultrasound in the diagnosis and treatment of tubo-ovarian abscess. Br J Obstet Gynaecol. Feb 1990;97(2):178-80. [Medline].

  16. Timor-Tritsch. The fallopian tubes. In: Transvaginal Sonography. 2nd ed. Lippincott Williams & Wilkins;1991: 131-4.

  17. Villalba ML, Huynh B, So M. An ovary with a twist: a case of interesting sonographic findings of ovarian torsion. J Emerg Med. Nov 2005;29(4):443-6. [Medline].

  18. Williams PL, Laifer-Narin SL, Ragavendra N. US of abnormal uterine bleeding. Radiographics. May-Jun 2003;23(3):703-18. [Medline].

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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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