Gynecology MiniLectures for Students Technique Transvaginal Ultrasound Anatomy Key Points The uterus does NOT stand straight up in the coronal plane It flops either forwards or backwards to lay on the bladder or on the rectum ID: 656388
Download Presentation The PPT/PDF document "Transvaginal ultrasound" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Transvaginal ultrasound
Gynecology Mini-Lectures for StudentsSlide2
Technique
Transvaginal
UltrasoundSlide3
Anatomy: Key Points
The uterus does
NOT
stand straight up in the coronal plane
It flops either forwards or backwards to lay on the bladder or on the rectum
Anteverted/retroverted
WRONG
rightSlide4
Anatomy: Key Points
The vaginal
fornices
are very stretchy
Source: Lentz: Comprehensive Gynecology, 6
th
ed. 2012 Mosby. Figure 7-12.
In this image, the surgeons hand is INSIDE her vagina.
See how much the anterior fornix can be stretched to perform bimanual massage of the uterus
Source: aafp.org
fornicesSlide5
Anatomy: Key Points
The
transvaginal
ultrasound probe is placed in the anterior or posterior fornix. This allows the probe to push up against the side of the cervix.
Anteverted
uterus. Probe in anterior fornix.
Retroverted
uterus. Probe in posterior fornix.Slide6
Understanding ultrasound images
This is how you obtain a
sagittal
image of the uterus
PROBESlide7
Understanding ultrasound images
Rotate probe 90 degrees to obtain a transverse image
PROBESlide8
Understanding ultrasound images
As you can see from this image, it is impossible to obtain a “head-on” or “coronal” view of the uterus using normal
transvaginal
ultrasound. The probe would have to be outside the vagina.
vagina
PROBESlide9
Understanding ultrasound images
The “head-on” or “coronal” view of the uterus can only be obtained by creating a 3D reconstruction of the
sagittal
and transverse imagesSlide10
Advantages
Transvaginal
UltrasoundSlide11
Advantages
It is difficult to see the pelvic organs from a trans-abdominal perspective
Pubic bone creates shadows
There is a long distance between probe and organs
Source: http://www.hopkinsmedicine.org/healthlibrary/GetImage.aspx?ImageId=161389Slide12
Advantages
Transvaginal
probe is right next to uterus
Probe has higher frequency=better image resolution, lower penetration
Source: http://www.hopkinsmedicine.org/healthlibrary/GetImage.aspx?ImageId=161389Slide13
Transvaginal vs
abdominal
These images are from the same patient. Notice the greater image resolution with
transvaginal
imaging. You can better delineate the
endometrium
, internal
os, and character of the myometrium.uterusbladder
vagina
fundus
endometrium
cervixSlide14
Procedure
Transvaginal
UltrasoundSlide15
Procedure
Patient should empty her bladder
Patient lays in
lithotomy
position
Gel placed on ultrasound probeImproves transmission of ultrasound wavesSterile probe cover placed on probeGel placed over probe cover
Patient or sonographer inserts probeImages obtainedSlide16
Procedure
The
components of a typical gynecologic
sonographic
examination
include:Uterine size, shape, and orientationEvaluation of endometrium
, myometrium, and cervixIdentification and morphology of ovaries, if possibleAssessment
of the uterus and adnexa for masses, cysts, hydrosalpinges, fluid collectionsEvaluation of the cul-de-sac for free fluid or massesNormal fallopian tubes usually cannot be seen during pelvic sonographySource: UpToDate, “Ultrasound examination in obstetrics and gynecology.”Slide17
Color flow
Doppler color flow mapping uses different colors to depict the
direction
of flow on a
real-time
color imageUseful to determine:Presence of flowRule out ovarian torsion
Vascularity of a massCharacterize the massVascularity of the
endometrium/myometriumDistinguish benign versus malignant conditionsSlide18
Color flow
Ovary with normal blood flow
Ovarian torsion (no flow)
Mass in
endometrium
. Color flow reveals multiple vessels=fibroid
Retained products of conception, demonstrated by increased flow to
endometriumSlide19
Indications
Transvaginal
UltrasoundSlide20
Indications
Gynecologic
ultrasound examination has multiple uses, including but not limited
to:
Evaluation
of the menstrual cycle (endometrial thickness, follicular development)Monitoring natural or stimulated follicular development during infertility therapyLocalization
of an intrauterine deviceEvaluation of abnormal uterine bleedingAssessment of a pelvic mass (eg
, adenomyosis, fibroid, cancer, cysts)Evaluation for sequelae of pelvic infection (eg, abscess, hydrosalpinx)Evaluation of congenital uterine anomaliesScreening for malignancySource: UpToDate, “Ultrasound examination in obstetrics and gynecology.”