Pelvic Ultrasonography 

  • Author: Shoreh Kooshesh, MD; Chief Editor: Gowthaman Gunabushanam, MD, FRCR   more...
 
Updated: Sep 14, 2011
 

Background

Pelvic sonography may be viewed as a form or extension of the physical examination. It is one of the best imaging modalities used to evaluate nonspecific pelvic pain, pregnancy complications, anatomy of pelvic organs, and various ovarian pathologies.[1]

In transabdominal scanning, using a low-frequency transducer, a full bladder is used to displace bowel gas and serve as an acoustic window to improve image resolution and to allow a large viewing field of the pelvis. Endovaginal scanning, using a high-frequency transducer, is the preferred technique for emergency physicians because a full bladder is not necessary.[2] It also provides higher resolution, which allows better evaluation of the structure, anatomy, and pathology of pelvic organs.[2] Endovaginal scanning is preferred over computed tomography because of the absence of radiation exposure with ultrasonography, decreased time of hospital stay, and decreased cost to patient.[3]

The video below depicts a demonstration of transvaginal ultrasonography.

Demonstration of a transvaginal ultrasonographic pelvic evaluation. Video courtesy of Meghan Kelly Herbst, MD. Also courtesy of Yale School of Medicine, Emergency Medicine.
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Contributor Information and Disclosures
Author

Shoreh Kooshesh, MD  Resident Physician, Division of Emergency Medicine, Stanford University School of Medicine

Shoreh Kooshesh, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Student Association/Foundation, American Women's Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Laleh Gharahbaghian, MD  Co-Director, Emergency Ultrasound Fellowship, Associate Director, Emergency Ultrasound, Clinical Instructor, Division of Emergency Medicine, Stanford University Medical Center

Laleh Gharahbaghian, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James Quan-Yu Hwang, MD, RDMS, RDCS, FACEP  Staff Physician, Emergency Department, Kaiser Permanente

James Quan-Yu Hwang, MD, RDMS, RDCS, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine

Disclosure: 3rd Rock Ultrasound, LLC Salary Speaking and teaching; Schlesinger Associates Consulting fee Consulting; Philips Ultrasound Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of 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: Nothing to disclose.

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

Gowthaman Gunabushanam, MD, FRCR  Assistant Professor, Department of Diagnostic Radiology, Yale University School of Medicine

Gowthaman Gunabushanam, MD, FRCR is a member of the following medical societies: American Roentgen Ray Society, Connecticut State Medical Society, and Society of Interventional Radiology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Verena T Valley, MD, and Christopher A Fly, MD, to the development and writing of this article.

Medscape Reference thanks Meghan Kelly Herbst, MD, Emergency Ultrasound Director, Department of Emergency Medicine, Hartford Hospital, for assistance with the video contribution to this article. Medscape Reference also thanks Yale School of Medicine, Emergency Medicine for assistance with the video contribution to this article.

References

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Transabdominal longitudinal view of the female pelvis.
Transabdominal transverse view of the female pelvis: The bladder is rectangular. The ovaries are seen bilaterally in the adnexa.
Endovaginal longitudinal view of the uterus: The endometrial stripe (st) is thickened. The arcuate vessels (arc) can be seen within the uterus and should not be confused with free fluid in the cul-de-sac.
Endovaginal view of the ovary: Note its location adjacent to an iliac vessel.
Endovaginal ultrasound scan. Endometritis with air in the endometrial cavity and bilateral tubo-ovarian abscesses are shown.
Video depicts 2 findings: first, it shows an enlarged hypovascular left ovary; second, it shows flow in the healthy right ovary. A small amount of intraperitoneal fluid surrounds the left ovary.
Demonstration of a transvaginal ultrasonographic pelvic evaluation. Video courtesy of Meghan Kelly Herbst, MD. Also courtesy of Yale School of Medicine, Emergency Medicine.
Cine loop depicting transvaginal ultrasonography with free fluid in the uterus and right ovary. Video courtesy of Meghan Kelly Herbst, MD. Also courtesy of Yale School of Medicine, Emergency Medicine.
Cine loop of transvaginal ultrasonography showing free fluid in the uterus. Video courtesy of Meghan Kelly Herbst, MD. Also courtesy of Yale School of Medicine, Emergency Medicine.
 
 
 
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