Pelvic sonography may be viewed as a form or extension of the physical examination. In transabdominal scanning, a full bladder is used to displace bowel gas and serve as an acoustic window to allow a large viewing field of the pelvis. Endovaginal imaging is the preferred technique for emergency physicians because a full bladder is not necessary. Filling the bladder delays the examination.
Clinical
History
Clinical indications for pelvic sonography include the following:
* Evaluation of vaginal bleeding in early pregnancy
o This indication is well outlined in Pregnancy, Ectopic.
o Subchorionic hemorrhage (implantation bleeding) is a common cause of spotting.
o Endovaginal scanning uses a high-frequency transducer and enables optimal imaging of organs close to the probe, including the endometrium, myometrium, cul-de-sac, and ovaries, which can be seen in detail.
* Evaluation of pelvic pain
o Ultrasonography can be used to evaluate pelvic pain, a common complaint of patients presenting to the ED, and entities such as ovarian cysts, tubo-ovarian abscesses, uterine fibroids, or even an infected pelvic kidney.
o In a female patient who is obese, pelvic ultrasonography can simplify a difficult physical examination.
* Evaluation of a pelvic mass
o Pelvic ultrasonography can be used to determine the etiology of a pelvic mass.
o Compared with endovaginal ultrasonography, transabdominal ultrasonography uses a lower frequency and can penetrate farther, with a large field of view. Thus, fibroids, ovaries, or cysts located high in the pelvis may be out of the focal range of an endovaginal probe. In addition, pelvic kidneys can be visualized.
* Evaluation of pelvic infection
o Tubo-ovarian abscesses are difficult to diagnose at physical examination.
o A normal fallopian tube may not be visualized at endovaginal ultrasonography; however, a fluid- or pus-filled tube can be identified.
o Pelvic inflammatory disease can be identified at ultrasonography.
* Localization of an intrauterine device or foreign body
o Ultrasonography can aid in the localization or detection of an intrauterine device or foreign body.
o An intrauterine device produces a characteristic acoustic artifact (shadow), which is helpful to the physician sonographer.
* Evaluation of trauma
o Views of the pelvis are used at ultrasonographic examination to evaluate for free fluid or clotted blood, which can be present in the pouch of Douglas (cul-de-sac).
o Views of the pelvis obtained before insertion of a Foley catheter are helpful.
* Evaluation of abnormal uterine bleeding in the premenopausal patient as well as the postpartum and postabortion patient
Clinical
History
Clinical indications for pelvic sonography include the following:
* Evaluation of vaginal bleeding in early pregnancy
o This indication is well outlined in Pregnancy, Ectopic.
o Subchorionic hemorrhage (implantation bleeding) is a common cause of spotting.
o Endovaginal scanning uses a high-frequency transducer and enables optimal imaging of organs close to the probe, including the endometrium, myometrium, cul-de-sac, and ovaries, which can be seen in detail.
* Evaluation of pelvic pain
o Ultrasonography can be used to evaluate pelvic pain, a common complaint of patients presenting to the ED, and entities such as ovarian cysts, tubo-ovarian abscesses, uterine fibroids, or even an infected pelvic kidney.
o In a female patient who is obese, pelvic ultrasonography can simplify a difficult physical examination.
* Evaluation of a pelvic mass
o Pelvic ultrasonography can be used to determine the etiology of a pelvic mass.
o Compared with endovaginal ultrasonography, transabdominal ultrasonography uses a lower frequency and can penetrate farther, with a large field of view. Thus, fibroids, ovaries, or cysts located high in the pelvis may be out of the focal range of an endovaginal probe. In addition, pelvic kidneys can be visualized.
* Evaluation of pelvic infection
o Tubo-ovarian abscesses are difficult to diagnose at physical examination.
o A normal fallopian tube may not be visualized at endovaginal ultrasonography; however, a fluid- or pus-filled tube can be identified.
o Pelvic inflammatory disease can be identified at ultrasonography.
* Localization of an intrauterine device or foreign body
o Ultrasonography can aid in the localization or detection of an intrauterine device or foreign body.
o An intrauterine device produces a characteristic acoustic artifact (shadow), which is helpful to the physician sonographer.
* Evaluation of trauma
o Views of the pelvis are used at ultrasonographic examination to evaluate for free fluid or clotted blood, which can be present in the pouch of Douglas (cul-de-sac).
o Views of the pelvis obtained before insertion of a Foley catheter are helpful.
* Evaluation of abnormal uterine bleeding in the premenopausal patient as well as the postpartum and postabortion patient
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