Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5f56664f6-287w5 Total loading time: 0 Render date: 2025-05-07T08:12:28.757Z Has data issue: false hasContentIssue false

6 - Ultrasound in the acute pelvis

Published online by Cambridge University Press:  04 March 2010

By
Hassan Massouh
Edited by
Jane Bates
Hassan Massouh
Affiliation:
Frimley Park Hospital, Frimley, Surrey
Jane Bates
Affiliation:
St James's University Hospital, Leeds
Get access

Summary

Introduction

Ultrasound is the first examination of choice in patients with acute pelvic pain, regardless of age, presentation or gender, and a more common request in females than males. Pelvic pain represents 10–15% of all urgent ultrasound examinations performed in a district general hospital (local audit) and results from a large variety of underlying causes, many of which may be gynaecological. The causes of pain vary and will depend upon the location, organ involved and underlying pathology such as infection, haemorrhage, infarct or ectopic pregnancy (EP).

The examination of choice in these circumstances is a combination of transabdominal (TA) and transvaginal (TV) ultrasound except in young girls and those with an intact hymen. The use of high-frequency vaginal probes and the proximity of the probe to the pelvic organs allow clear visualisation of the pelvic organs. The ability of the vaginal probe to touch the pelvic organs allows the sonographer to test for pain and detect the mobility of these organs, which are two important and useful signs in evaluating the cause of pelvic pain.

TA ultrasound is advantageous because of its ability to visualise large pelvic masses, detect the presence of ascites and examine other structures such as the kidneys and the other upper abdominal organs, which may be associated with the pain. However, TA ultrasound may be technically difficult in acute pelvic pain due to the presence of ileus, abdominal wall tenderness/rigidity and the lack of filling of the urinary bladder (which is frequently associated in particular with pelvic inflammation).

Type
Chapter
Information
Practical Gynaecological Ultrasound , pp. 103 - 119
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Skjeldestad, F. E., Kendrick, J. S., Atrash, H. K. and Daltveit, A. K., Increasing incidence of ectopic pregnancy in one Norwegian county – a population based study, 1970–1983. Acta Obstetrica Gynecologica Scandinavica, 76 (1997), 159–65.CrossRefGoogle Scholar
Chow, W. H., Daling, J. R., Cates, W.et al., Epidemiology of ectopic pregnancy. Epidemiological Review, 9 (1987), 71–94.CrossRefGoogle ScholarPubMed
Ikeda, S., Sumiyoshi, M., Nakae, M.et al., Heterotopic pregnancy after in vitro fertilization and embryo transfer. Acta Obstetrica Gynecologica Scandinavica, 77 (1998), 463–4.Google ScholarPubMed
Mehta, T. S., Levine, D. and Beekwith, B., Treatment of ectopic pregnancy: is a hCG level of 2000 mLU/ml a reasonable threshold?Radiology, 205 (1997), 569–73.CrossRefGoogle Scholar
Kadar, N., Bohrer, M., Kemmann, E.et al., The discriminatory chorionic gonadotropin zone for endovaginal sonography: a prospective randomised study. Fertility and Sterility, 61 (1994), 1016–20.CrossRefGoogle Scholar
Dart, R., Ramanujam, P. and Dart, L., Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate. American Journal of Emergency Medicine, 20 (2002), 575–9.CrossRefGoogle ScholarPubMed
Frate, M. C. and Laing, F. C., Sonographic evaluation of ectopic pregnancy: an update. American Journal of Roentgenology, 165 (1995), 251–9.CrossRefGoogle Scholar
Stoval, T. G. and Ling, F. W., Single dose methotrexate: an expanded clinical trial. American Journal of Obstetrics and Gynecology, 168 (1993), 1759–65.CrossRefGoogle Scholar
Yao, M. and Tulandi, T., Current status of surgical and nonsurgical management of ectopic pregnancy. Fertility and Sterility, 67 (1997), 421–33.CrossRefGoogle ScholarPubMed
Cohen, C. R., Manhart, L. E., Bukusi, E. A.et al., Association between Mycoplasma genitalium and acute endometritis. Lancet, 359 (2002), 765–6.CrossRefGoogle ScholarPubMed
Clinical Effectiveness Group, UK National Guidelines on Sexually Transmitted Infections. 2002. Pelvic Inflammatory Disease. Available online at: www.agum.org.uk/ceg2002/pid0601.htm.2002.
Royal College of Obstetricians and Gynaecologists, Guidelines no. 32. Acute Pelvic Inflammatory Disease, Management of (London: Royal College of Obstetricians and Gynaecologists, 2003).
Bulas, D. I., Ahlstrom, P. A., Sivit, C. J.et al., Pelvic inflammatory disease in the adolescent: comparison of transabdominal and transvaginal sonographic evaluation. Radiology, 183 (1992), 435–9.CrossRefGoogle ScholarPubMed
Tukeva, T. A., Aronen, H. J., Karjalainen, P. T.et al., MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology, 210 (1999), 209–16.CrossRefGoogle ScholarPubMed
Tikanen, H. and Kujansuu, E., Doppler ultrasound findings in tubo-ovarian infectious complex. Journal of Clinical Ultrasound, 21 (1993), 175–8.CrossRefGoogle Scholar
Molander, P., Sjoberg, J., Paavonen, J. and Cacciatore, B., Transvaginal power Doppler findings in laparoscopically proven acute pelvic inflammatory disease. Ultrasound in Obstetrics and Gynecology, 17 (2002), 233–8.CrossRefGoogle Scholar
Timor-Tritsch, I. E., Lerner, J. P., Monteagudo, A.et al., Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound in Obstetrics and Gynecology, 12 (1998), 56–66.CrossRefGoogle ScholarPubMed
Ross, J. D. C., Pelvic inflammatory disease: how should it be managed?Current Opinion in Infectious Diseases, 16 (2003), 37–41.CrossRefGoogle ScholarPubMed
Sonnenberg, E., D'Agostino, H. B., Casola, G.et al., US-guided transvaginal drainage of pelvic abscesses and fluid collections. Radiology, 181 (1991), 53–6.CrossRefGoogle Scholar
Wit, W., Gowrising, C. J., Kuik, D. J.et al., Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rate after IVF. Human Reproduction, 13 (1998), 1696–701.CrossRefGoogle Scholar
Mukherjee, T., Copperman, A. B., McCaffrey, C.et al., Hydrosalpinx fluid has embryotoxic effect on murine embryogenesis: a case for prophylactic salpingectomy. Fertility and Sterility, 66 (1996), 851–3.CrossRefGoogle ScholarPubMed
Outwater, E. K., Siegelman, E. S., Chiowanich, P.et al., Dilated fallopian tubes: MRI imaging characteristics. Radiology, 208 (1998), 463–9.CrossRefGoogle Scholar
Guerriero, S., Ajossa, S., Lai, M. P.et al., Transvaginal ultrasonography associated with colour Doppler energy in the diagnosis of hydrosalpinx. Human Reproduction, 15 (2000), 1568–72.CrossRefGoogle Scholar
Okai, T., Kobayashi, K., Ryo, E.et al., Transvaginal sonographic appearance of hemorrhagic functional ovarian cyst and their spontaneous regression. International Journal of Gynaecology and Obstetrics, 44 (1994), 47–52.CrossRefGoogle ScholarPubMed
Baltarowich, O. H., Kurtz, A. B., Pasto, M. E.et al., The spectrum of sonographic findings in hemorrhagic ovarian cyst. American Journal of Roentgenology, 148 (1987), 901–5.CrossRefGoogle Scholar
Kiran, A. and Jain, M. D., Sonographic spectrum of hemorrhagic ovarian cyst. Journal of Ultrasound Medicine, 21 (2002), 879–86.Google Scholar
Hallatt, J. G., Steele, C. H. and Snyder, M., Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases. American Journal of Obstetrics and Gynecology, 149 (1984), 5–9.CrossRefGoogle ScholarPubMed
Hertzberg, B. S., Kliewer, M. A. and Paaulson, E. K., Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis. Abdominal Imaging, 24 (1999), 304–8.CrossRefGoogle ScholarPubMed
Hibbard, L. T., Adnexal torsion. American Journal of Obstetrics and Gynecology, 152 (1985), 456–61.CrossRefGoogle ScholarPubMed
Graif, M. and Itzchak, Y., Sonographic evaluation of ovarian torsion in childhood and adolescence. American Journal of Roentgenology, 150 (1988), 647–9.CrossRefGoogle ScholarPubMed
Stark, J. E. and Siegel, M. J., Ovarian torsion in prepubertal and pubertal girls: sonographic findings. American Journal of Roentgenology, 163 (1994), 1479–82.CrossRefGoogle ScholarPubMed
Warner, M. A., Fleischer, A. C., Edell, S. L.et al., Uterine adnexal torsion: sonographic findings. Radiology, 154 (1985), 773–5.CrossRefGoogle ScholarPubMed
Albayram, F. and Hamper, U. M., Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. Journal of Ultrasound Medicine, 20 (2001), 1083–9.CrossRefGoogle ScholarPubMed
Lee, E. J., Kwon, H. C., Joo, H. J.et al., Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. Journal of Ultrasound Medicine, 17 (1998), 83–9.CrossRefGoogle ScholarPubMed
Shalev, J., Mashiach, R., Bar-Hava, I.et al., Subtorsion of the ovary: sonographic features and clinical management. Journal of Ultrasound Medicine, 20 (2001), 849–54.CrossRefGoogle ScholarPubMed
Rha, S. E., Byun, J. Y., Jung, S. E.et al., CT and MR imaging features of adnexal torsion. Radiographics, 22 (2002), 283–94.CrossRefGoogle Scholar
Nghiem, H. V. and Jeffry, R. B. Jr., Acute appendicitis confined to the appendiceal tip: evaluation with graded compression sonography. Journal of Ultrasound Medicine, 11 (1992), 205–7.CrossRefGoogle ScholarPubMed
Puylaert, J. B. C. M., Acute appendicitis: US evaluation using graded compression. Radiology, 158 (1986), 355–60.CrossRefGoogle ScholarPubMed
Rettenbacher, T., Hollerweger, A., Macheiner, P.et al., Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis – evaluation with US. Radiology, 226 (2003), 95–100.CrossRefGoogle ScholarPubMed
Poortman, P., Lohle, P. N. M., Schoemaker, C. M. C.et al., Comparison of CT and sonography in the diagnosis of acute appendicitis: a blind prospective study. American Journal of Roentgenology, 181 (2003), 1355–9.CrossRefGoogle Scholar
Fujii, Y., Hata, J., Futagami, K.et al., Ultrasonography improves diagnostic accuracy of acute appendicitis and provide cost saving to hospitals in Japan. Journal of Ultrasound Medicine, 19 (2000), 409–14.CrossRefGoogle Scholar
O'Malley, M. E. and Wilson, S. R., US of gastrointestinal tract abnormalities with CT correlation. Radiographics, 23 (2003), 59–72.CrossRefGoogle ScholarPubMed
Parulekar, S. G., Sonography of colonic diverticulitis. Journal of Ultrasound in Medicine, 12 (1985), 659–66.CrossRefGoogle Scholar
Spevak, M. R. and Cohen, H. L., Ultrasonography of the adolescent female pelvis. Ultrasound Quarterly, 18 (2002), 275–88.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×