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You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
When I began my involvement with diagnostic sonography nearly 4 decades ago, this chapter would have been considered ludicrous. Virtually all of sonography was considered to be either an artifact or a pitfall. Clinicians did not take this modality seriously, and few critical decisions were ever based on the results of the ultrasound examination alone. With time, improvements in both technology and our understanding of normal…
Summary of Key Points Ultrasound (US) has an important role in planning and guiding many gynecologic interventions. Prior to endometrial ablation, US may be used to detect focal lesions (e.g., polyps or leiomyomas), assess for tubal disease such as hydrosalpinx, and search for uterine anomalies. Whereas magnetic resonance imaging (MRI) remains the gold standard for evaluating patients prior to uterine artery embolization (UAE), US can be…
Summary of Key Points Magnetic resonance imaging (MRI) is a problem-solving tool and has greater accuracy and specificity for characterization of gynecologic masses than sonography or computed tomography (CT), but should generally be performed after pelvic sonography. High resolutionT2-weighted sequences are the mainstay images for evaluation of nonobstetric gynecologic disorders. T1-weighted imaging must be performed with and without fat suppression if characterization of fat or blood…
Summary of Key Points Endoanal sonography has an important role in the assessment of the anal sphincter in patients with fecal incontinence. Sonography and magnetic resonance imaging (MRI) of the pelvic floor can be useful in evaluation of women with pelvic floor disorders and in assessment of mesh implants. There is no strong evidence for routine use of pelvic floor sonography in assessment of women with…
Summary of Key Points Reproductive tract anomalies may present at different stages of life. Most abnormalities of the external genitalia are obvious at birth, whereas obstructive and nonobstructive lesions of the reproductive tract may be evident at birth or present later during childhood, at puberty, in adolescence, or during adulthood. Sonography is used to determine the presence of a uterus and gonadal location in patients with…
Summary of Key Points The incidence of ectopic pregnancy (EP) in the United States is increasing as a result of an increase in the number of patients with risk factors as well as an increase in diagnosis due to earlier presentation and detection. Mortality rate from EP is decreasing because of improved diagnostic techniques and heightened awareness among clinicians and patients. The most common predisposing risk…
Summary of Key Points Transvaginal sonography (TVS) provides valuable information as part of the initial evaluation of an infertile patient. EVS has an essential role in monitoring endometrial thickness and morphology as well as follicular development during hormonal stimulation. EVS or transabdominal sonography provides guidance for oocyte retrieval. Postretrieval complications such as ovarian hyperstimulation, hemorrhage, and infection are optimally imaged with sonography. Infertility can be defined…
Summary of Key Points Normal fallopian tubes are difficult to visualize with ultrasound unless surrounded by small amounts of free peritoneal fluid. Classic sonographic signs that help distinguish a dilated fallopian tube from other cystic adnexal masses include waist, incomplete septation, cogwheel, and beads on a string signs. Acute pyosalpinx is diagnosed on ultrasound examination by the finding of a dilated, tubular adnexal structure filled with…
Summary of Key Points A simple cyst less than 3 cm in the ovary of a premenopausal patient is best termed a follicle and is a normal finding. A simple cyst less than 1 cm in the ovary of a postmenopausal patient is considered inconsequential. Most ovarian masses are benign and have a typical sonographic appearance that allows accurate diagnosis. Many simple and hemorrhagic cysts do not need…
Summary of Key Points Pelvic pain in the reproductive age patient often presents a diagnostic challenge as there are many causes, including both gynecologic and nongynecologic disorders with overlap in clinical symptoms. Pregnancy status must always be determined to exclude a pregnancy-related complication, particularly ectopic pregnancy. Pelvic sonography is the well-established first-line imaging method of choice and may require both a transabdominal and transvaginal approach to…
Summary of Key Points Sonography is the imaging modality of choice for evaluation of the myometrium, with magnetic resonance imaging (MRI) reserved as a problem-solving technique. Many müllerian duct anomalies can be accurately diagnosed with sonography, and three-dimensional (3D) imaging of the fundal contour is diagnostic in differentiating the bicornuate uterus (>1 cm fundal cleft between the two horns) and the septate uterus. Adenomyosis presents most commonly…
Summary of Key Points Abnormal uterine bleeding is most commonly due to dysfunctional anovulatory bleeding in premenopausal women and endometrial atrophy in postmenopausal women. Approximately 90% of endometrial cancer occurs after age 50, with the most common symptom being abnormal vaginal bleeding. Transvaginal sonography (EVS) is the initial step in the workup of postmenopausal bleeding; however, if the endometrium is not adequately visualized EVS must be…
Summary of Key Points Transabdominal sonography (TAS) and transvaginal sonography (TVS) are often complementary, providing different diagnostic information. TAS provides a wider field of view and better visualization of superficial structures and large pelvic masses but has limited resolution. The transvaginal approach allows the probe to be placed closer to the “target organs,” providing higher resolution imaging, but has a limited field of view. Because of…
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Summary of Key Points Sonography has transformed the field of fetal therapy and serves as the widely available, necessary diagnostic and intraoperative guidance tool. The potential benefits of open maternal-fetal surgery must be weighed against the potential maternal and fetal risks, which have the potential of complicating the index pregnancy and subsequent pregnancies. Minimally invasive fetal surgery is associated with much lower maternal risks and is…