Pelvic ultrasound

Pelvic ultrasound may be used to identify anatomic abnormalities such as masses/lesions or to detect ovarian cysts and endometriomas. 

All patients with chronic pelvic pain should have the benefit of clinical evaluation and shared care by a physician with expertise in chronic pelvic pain. A laparoscopy and pelvic ultrasound should be performed prior to radiologic interventions. Their role is to exclude other diagnoses, not to make the diagnosis of pelvic congestion. If the clinical presentation is recurrent lower extremity varicose veins or... 

Ovarian cysts are frequently seen during prenatal and postnatal pelvic ultrasound and have, therefore, been included in this chapter, although they are not closely related etiologically to the above-mentioned malformations and organ systems. 

For all other anomalies, especially multicystic dysplastic kidney, renal ectopia, or unilateral agenesis, the workup should also include US and eventually a VCU in order to detect ipsi- or contralateral VUR, which would require prophylactic chemotherapy (AxiYEHetal. 1993 Flack and Bellinger 1993 Selzman and Elder 1995 Ismaili et al. 2005). Also of interest is to search for associated genital anomalies on pelvic ultrasound (Table 13.5) (Riccabona et al. 2006). 

Abdomen Unexplained hypotension may be the result of an internal hemorrhage. Peritoneal lavage, ultrasound, and abdominal CT may be necessary to rule out injury. Frequent reassessment is necessary as signs of abdominal injury change with time. Avoid pelvic manipulation if possible due to the potential for internal hemorrhage. 

The role of imaging in uterine fibroids is not only to characterize the number, type and size of the tumors, but also to screen for other causes of the presenting symptoms. Ultrasound is typically the initial imaging modality used in the work-up of uterine fibroids, but it is subject to operator variability and therefore lacks reproducibility (Fig. 10.2.2). Ultrasound is best suited as a screening test for fibroids and to exclude any obvious pelvic pathology. MRI not only provides the consistency required for postprocedure comparisons [13, 26], but also reliably excludes adenomyosis and all but stage I carcinomas of the endometrium [13]. At our institution the same MR sequences are used pre and post UAE and are described in Table 10.2.1. 

Beer-Gabel M, Teshler M, Barzilai N, LurieY, Malnick S, Bass D, Zbar A (2002) Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders. Dis Colon Rectum 45 239-248... 

Fig. ll.la-e. A 49-year-old woman with chronic left pelvic pain and an office ultrasound suspicious for bilateral ovarian cancer.(seepage 266)... 

Bazot M, Thomassin I, Hourani R, Cortez A, Darai E (2004) Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 24 180-185... 

Pelvic Lesions. While transrectal and transvaginal biopsies are routinely guided using ultrasound, the access routes for CT-guided biopsy in the pelvis include ... 

Sourtzis S, Damry N, Janssen F et al (1994) Ureteral quadru-plication. Pediatr Radiol 24 604-605 Stocks A, Richards D, Frentzen B et al (1996) Correlation of prenatal pelvic antero-posterior diameter with outcome in infancy. JUrol 155 1050-1052 Tressider GC, Blandy JP, Murray RS (1970) Pyelo-pelvic and uretero-ureteric reflux. B J Urol 42 728-735 Trigaux JP, Van Beers B, Delchambre F (1991) Male genital tract malformations associated with ipsilateral renal agenesis. J Clin Ultrasound 19 3-10... 

Narrowing differential diagnosis of the possible cause of urogenital sinus as well as demonstration of its anatomical features can be achieved at a high confidence level using contrast studies and ultrasound to assess pelvic structures and the adrenal glands. 

To assess pelvic structures in doacal malformation, ultrasound should be performed as soon as possible after birth since no or only a small amount of intestinal gas will be present. Fluoroscopic studies to demonstrate the complex anatomy as well as to evaluate the urinary tract and the inner genitalia for diagnostic purposes are mandatory. 

Chertin B, Hadas-Halpern I, Fridmans A, Kniznik M, bu-Arafeh W, Zilberman M, Farkas A (2000) Transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia. J Clin Ultrasound 28 122-124... 

McAleer IM, Kaplan GW (1999) Renal function before and after pyeloplasty does it improve J Urol 162 1041-1044 McHugo J, Wittle M (2001) Enlarged fetal bladders etiology management and outcomes. Prenat Diagn 21 958-963 Meizner I, Bernhard Y (1995) Bilateral fetal pelvic kidneys. J Ultrasound Med 14 487-489... 

---