EP29.12: Pelvic pathology diagnosed with transvaginal ultrasound

Abstract

Throughout the world, transvaginal ultrasound (TVU) is considered a fundamental tool for gynecological work-up. TVU was initially adopted only to investigate pathologies of female genital tract, but currently TVU is also used to evaluate the extension of pathologies into the pelvis, outside the uterus or ovaries (oncological conditions and endometriosis). Moreover TVU can visualise structures that cannot be classified as gynecological pathologies but rather as pelvic pathologies. The aim of this study is to relate our experience with pelvic pathologies and our attempts to interpret those new US findings properly in order to achieve the correct diagnosis. We reviewed our case series and we selected cases of 1 pelvic schwannomas, 2 cases of GIST (gastrointestinal stromal tumours), 4 cases of post-operative urinoma, 1 case of bowel cancer, 1 case of cyst of sacral roots, 1 case of ectopic spleen, 1 case of pelvic lymphoma, 1 case of metastasys of pancreatic cancer; one case of pelvic recidive of Vater papilla tumour; one case of pelvic spread of melanoma; 1 case of chorincarcinoma arising from ectopic tubal pregnancy; 1 case of bowel volvulus. At TVU, pelvic schwannomas appeared as rounded masses, with a semi-solid structure having a regular border and intralesional hyperechoic areas. GISTs at ultrasound can show a hyperechoic core due to mixoid degeneration or leiomyomas or microcystis into the mass. Urinoma is a “pelvic pseudocyst” due to ureteral injury and is identified mainly on colour Doppler examination. Other lesions appear like a solid mass with irregular borders with eterogeneous echogenicity, highly vascularised at power Doppler investigation. Bowel volvulus was suspected by abnormal morphology of visceral wall, by intestinal contents and by clinical symptoms. Not only can the genital tract be visualised during TVU, but with this imaging method it is possible to visualise other pathological conditions as well, including those unrelated to gynecology.