Pelvic Ultrasonography

Pelvic Ultrasonography

No Results

No Results


Pelvic ultrasonography is one of the best imaging modalities used to evaluate nonspecific pelvic pain, pregnancy complications, anatomy of pelvic organs, and various ovarian pathologies. [1, 2, 3, 4, 5]

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 the evaluation of ovarian pathologies, and 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 improved visualization of pelvic organs, the absence of radiation exposure with ultrasonography, decreased time of hospital stay, and decreased cost to the patient. [3]

According to the American Institute of Ultrasound in Medicine (AIUM), indications for pelvic ultrasonography include but are not limited to the following [6] :


The video below depicts a demonstration of transvaginal ultrasonography.

Bau A, Atri M. Acute female pelvic pain: ultrasound evaluation. Semin Ultrasound CT MR. 2000 Feb. 21(1):78-93. [Medline].

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. 2004 Feb. 18(1):105-23. [Medline].

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

Sanders RC, Winter T. Clinical Sonography A Practical Guide. Fourth. Baltimore, MD Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

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

American Institute of Ultrasound in Medicine (AIUM), American College of Radiology (ACR), American College of Obstetricians and Gynecologists (ACOG), Society for Pediatric Radiology (SPR), Society of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of ultrasound of the female pelvis. J Ultrasound Med. 2014 Jun. 33 (6):1122-30. [Medline].

Philip CA, Bisch C, Coulon A, de Saint-Hilaire P, Rudigoz RC, Dubernard G. Correlation between three-dimensional rectosonography and magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: a preliminary study on the first fifty cases. Eur J Obstet Gynecol Reprod Biol. 2015 Apr. 187:35-40. [Medline].

Dupuis CS, Kim YH. Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women. Ultrasonography. 2015 Oct. 34 (4):258-67. [Medline].

Bhosale PR, Javitt MC, Atri M, Harris RD, Kang SK, Meyer BJ, et al. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Q. 2015 Nov 19. [Medline].

Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009 Mar. 52(1):2-20. [Medline].

Connolly A, Ryan DH, Stuebe AM, Wolfe HM. Reevaluation of discriminatory and threshold levels for serum β-hCG in early pregnancy. Obstet Gynecol. 2013 Jan. 121 (1):65-70. [Medline].

Wang R, Reynolds TA, West HH, Ravikumar D, Martinez C, McAlpine I, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011 Jul. 58 (1):12-20. [Medline].

Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion–a 15-year review. J Pediatr Surg. 2009 Jun. 44(6):1212-6; discussion 1217. [Medline].

Dane B, Dane C, Kiray M, Cetin A. Sonographic findings in adnexal torsion: a report of 34 cases. Arch Gynecol Obstet. 2009 Jun. 279(6):841-4. [Medline].

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

Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 2011 Sep. 30(9):1205-10. [Medline].

Testa AC, Bourne TH. Characterising pelvic masses using ultrasound. Best Pract Res Clin Obstet Gynaecol. 2009 Mar 18. [Medline].

Chiem AT, Chan CH, Ibrahim DY, Anderson CL, Wu DS, Gilani CJ, et al. Pelvic ultrasonography and length of stay in the ED: an observational study. Am J Emerg Med. 2014 Sep 6. [Medline].

Whiteley M, Dos Santos S, Harrison C, Holdstock J, Lopez A. Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology. 2014 Oct 16. [Medline].

Thamburaj R, Sivitz A. Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department?. Pediatr Emerg Care. 2013 Jan. 29(1):67-70. [Medline].

Medeiros LR, Rosa DD, da Rosa MI, Bozzetti MC. Accuracy of ultrasonography with color Doppler in ovarian tumor: a systematic quantitative review. Int J Gynecol Cancer. 2009 Feb. 19(2):230-6. [Medline].

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

Moloney F, Ryan D, Twomey M, Hewitt M, Barry J. Comparison of MRI and high-resolution transvaginal sonography for the local staging of cervical cancer. J Clin Ultrasound. 2016 Feb. 44 (2):78-84. [Medline].

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

Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, et al. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol. 2009 May 22. [Medline].

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

Matijevic R, Knezevic M, Grgic O, Zlodi-Hrsak L. Diagnostic accuracy of sonographic and clinical parameters in the prediction of retained products of conception. J Ultrasound Med. 2009 Mar. 28(3):295-9. [Medline].

Wolman I, Altman E, Fait G, Har-Toov J, Gull I, Amster R, et al. Evacuating retained products of conception in the setting of an ultrasound unit. Fertil Steril. 2009 Apr. 91(4 Suppl):1586-8. [Medline].

Adkins K, Minardi J, Setzer E, Williams D. Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound. Case Rep Emerg Med. 2016. 2016:9124967. [Medline].

Deshmukh S, Ghanouni P, Jeffrey RB. Early sonographic diagnosis of intrauterine device migration to the adnexa. J Clin Ultrasound. 2009 Sep. 37(7):414-6. [Medline].

Shaukat NM, Copeli N, Desai P. The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations. Emerg Med Pract. 2016 Mar. 18 (3):1-24. [Medline].

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

Boutin A, Jastrow N, Roberge S, Chaillet N, Bérubé L, Brassard N, et al. Reliability of 3-dimensional transvaginal sonographic measurement of lower uterine segment thickness. J Ultrasound Med. 2012 Jun. 31(6):933-9. [Medline].

Kamaya A, Shin L, Chen B, Desser TS. Emergency gynecologic imaging. Semin Ultrasound CT MR. 2008 Oct. 29(5):353-68. [Medline].

Barhate KP, Domkundwar S, Patil N, Pai B. Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy. J Clin Ultrasound. 2009 Apr 7. [Medline].

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

Col-Madendag I, Madendag Y, Kanat-Pektas M, Danisman N. Can sonographic endometrial pattern be an early indicator for tubal ectopic pregnancy and related tubal rupture?. Arch Gynecol Obstet. 2009 Apr 30. [Medline].

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

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

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

Guerriero S, Alcazar JL, Ajossa S, Melis GB. Modified ultrasound scanning is a cost-effective method for the detection of deep infiltrating endometriosis. Fertil Steril. 2009 May. 91(5):e38; author reply e39. [Medline].

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

Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril. 2008 Nov 4. [Medline].

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

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

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

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

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 Medical Womens Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Laleh Gharahbaghian, MD, FACEP, FAAEM Clinical Associate Professor of Emergency Medicine, Medical Director, Adult Emergency Medicine, Patient Safety Champion, Emergency Medicine, Stanford HealthCare, Director Emeritus, Emergency Ultrasound Program, Department of Emergency Medicine, Stanford University Medical Center and Stanford University School of Medicine

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exo Imaging.

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Zwanger, MD, MBA 

Mark Zwanger, MD, MBA is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

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, Society for Academic Emergency Medicine

Disclosure: Received salary from 3rd Rock Ultrasound, LLC for speaking and teaching; Received consulting fee from Schlesinger Associates for consulting; Received consulting fee from Philips Ultrasound for consulting.

The authors and editors of Medscape Reference 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.

Pelvic Ultrasonography

Research & References of Pelvic Ultrasonography|A&C Accounting And Tax Services