Transabdominal Pelvic Ultrasonography Research Articles

Correlation between imaging findings and hormonal markers at the onset of puberty in girls

IntroductionThis study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. MethodsWe included girls aged ≤11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. ResultsWe analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus >3.0 cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤8 years. ConclusionPelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.

Effect of the presence of polycystic ovary syndrome-related features on anti-Mullerian hormone and androstenedione levels in adolescents with or without menstrual irregularity.

To determine the variation in anti-Mullerian hormone (AMH) and androstenedione (A4) concentrations in adolescent girls, with or without menstrual cycle disorder in relation to phenotypic features of. PCOS. Adolescent girls (n = 129), age range 14-19years, were recruited in the cohort study. All participants were in the 4th or 5th year after menarche. Sixty-eight had menstrual irregularities, usually oligomenorrhea (OM), and 61 had regular menstruation (RM). AMH and A4 concentrations were measured. Hirsutism was recorded. Polycystic ovarian morphology (PCOM) was evaluated by transabdominal pelvic ultrasonography. Polycystic ovary syndrome (PCOS) features were defined according to Rotterdam consensus criteria. AMH and A4 were significantly higher in adolescent girls with OM than in girls with RM (p < 0.05). A4 and body mass index (BMI) of adolescents with OM was significantly higher in those with hirsutism than those without hirsutism (p = 0.01 and 0.008, respectively). There was a positive correlation between A4 and BMI (r: 0.327, p < 0.01). Logistic regression showed that the frequency of OM in the presence of PCOM was 10.8 times (95% CI 2.04-12.09) compared to those without PCOM. The highest AMH concentrations were found in girls with OM, hirsutism, and PCOM (p < 0.05). AMH and A4 are elevated in adolescents with oligomenorrhoea. High A4 is more prominent in the presence of hirsutism and is associated with increased BMI. PCOM, increases the likelihood of oligomenorrhea by about 10 times. AMH increase as the combination of clinical features of PCOS increases in adolescents with menstrual irregularity.

Correlación entre hallazgos de imagen y marcadores hormonales en el inicio de la pubertad femenina

IntroductionThis study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. MethodsWe included girls aged ≤ 11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. ResultsWe analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus> 3.0cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤ 8 years. ConclusionPelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.

Ultrasonographic and postmortem findings in camels (Camelus dromedarius) with abdominal disorders

This study was designed to describe the ultrasonographic findings in 33 dromedary camels with different abdominal disorders. These were categorised as pelvic abscesses (n=5), peritonitis (n=4), chronic enteritis (n=10) and intestinal obstruction (n=14). In camels with pelvic abscesses, transabdominal pelvic ultrasonography showed abdominal echogenic mass and aspirated contents were pus. A severely distended intact urinary bladder was imaged which contained echogenic sediments. In camels with peritonitis, transabdominal ultrasonography revealed echogenic fibrin threads floating in a hyperechoic peritoneal effusion. The intestines were also imaged floating in the fluid. Aspiration of a peritoneal fluid sample yielded a reddish coloured fluid. In camels with paratuberculosis, intestinal oedema, peritoneal effusion and enlargement of mesenteric lymph nodes were recorded. In camels with intestinal obstruction, transabdominal ultrasonographic examination showed distended intestinal loops with weak intestinal motility. Transrectal ultrasonography revealed a highly distended rumen. In severe cases, transabdominal ultrasonography revealed intestinal contents within the intestinal loops indicating perforation of the intestines. In conclusion, ultrasonography can be used, in the field and in Veterinary Teaching Hospitals, as a non-invasive diagnostic approach in camels with abdominal disorders, and therefore help in early diagnosis and prognosis of such cases.

Corpus luteum hemorrhage in a patient with aplastic anemia

Corpus luteum hemorrhage may lead to a life-threatening intraperitoneal hemorrhage in women with bleeding disorders. A 17-year-old girl with aplastic anemia presented to the emergency ward with complaints of severe abdominal pain for the last 24h. On examination, she was noted to be pale with circulatory compromise. Transabdominal pelvic ultrasonography revealed a left complex adnexal mass, 6.9×5.1×5.1cm(3) in size, with a large anechoic area of fluid in the abdomen. On laparoscopic exploration, there was a massive hemoperitoneum (2.6L) with a ruptured corpus luteum on the surface of the left ovary. Hemostatic electric coagulation was successfully applied to the bleeding surface. The patient recovered without incident and was transferred to a special hospital for blood disease treatment one week after surgery. We concluded that corpus luteum hemorrhage in women with aplastic anemia can cause therapeutic difficulties. Laparoscopy is feasible for the management of a massive intraperitoneal hemorrhage secondary to a ruptured corpus luteum in such patients.

Understanding the presentation of polycystic ovary syndrome (PCOS) in the adolescent population: results from a multispecialty adolescent PCOS program

OBJECTIVE: PCOS is increasingly appreciated in adolescents. The diagnostic criteria for this group are unclear, including the utility of transabdominal pelvic ultrasonography (TAS). We examined how TAS findings correlate with endocrine and metabolic parameters in adolescents with PCOS.

OB/GYN Resident Perceptions about Adolescent Health Care Training

Background: Perimenarchal onset of polycystic ovary syndrome (PCOS), the most common endocrinopathy of the premenopausal years, is increasingly appreciated. In adolescents meeting clinical criteria for PCOS, transabdominal pelvic ultrasonography (TAUS) is often utilized for evaluation of ovarian morphology. While polycystic appearing ovaries (PCO) constitute a diagnostic criterion for PCOS (Rotterdam criteria 2003), it remains to be determined if PCO as assessed by TAUS in adolescents tracks with other diagnostic criteria of PCOS such as biochemical hyperandrogenism. Methods: Thirty-two adolescent females were recruited from a multispecialty adolescent PCOS clinic into an ongoing IRB approved cohort study. Participants underwent a complete history and physical examination. TAUS was performed by a single trained radiologist and readings were divided into three groups: normal appearing ovaries (NAO), classic PCO (ovarian volume O10cm with $12 follicles measuring 2e9mm in diameter) and variant polycystic ovaries (VPO; normal ovarian volume with $12 small follicles). Biochemical measures of hyperandrogenism included total testosterone (T) and sex hormone binding globulin (SHBG); free T (%) was calculated. Statistical analyses were performed using one-way analysis of variance (ANOVA), t-test and Pearson correlation as appropriate. Data are presented as mean standard deviation. Results: Of the 32 adolescents (ages 15.5 1.9 years, BMI 30.4 7.6 kg/m), 29 (91%) reported oligomenorrhea or amenorrhea; clinical features of hyperandrogenism (acne and/or hirsutism) were acknowledged by all. The mean serum T level was 52.5 29.0 ng/dl (range 10e55 ng/dl). TAUS criteria as specified identified NAO in 41% of participants (13/32), PCO in 34% (11/32) and VPO in 25% (8/32). Those with classic PCO demonstrated significantly higher serum T levels compared to VPO (70.6 27.2 ng/dl vs. 41.4 20.6 ng/dl; p 5 0.004) and to NAO (38.6 21.9 ng/dl; p 5 0.02) groups. There was no difference in total T levels between the NOA and VPO groups, nor were there any differences in free T or SHBG levels between the 3 groups (pO0.05). While no relationship was observed between BMI and total T (p50.8), those demonstrating classic PCO were significantly heavier (BMI 32.1 8.3 kg/m) compared to those with VPO (25.3 3.2 kg/m, p50.04). Adolescents with NAO had a similar BMI as those with classic PCO (32.5 þ 7.9 kg/ m) and were also significantly heavier than the VPO group (p 5 0.03). Conclusions: In adolescents, TAUS is a meaningful component of the evaluation of polycystic ovary syndrome. A significant proportion of adolescents with menstrual irregularity and clinical features of hyperandrogenism had ovaries that did not demonstrate the classic PCO appearance. The VPO group had a significantly lower BMI than the NAO and PCO groups, and similar T levels as the NAO group; this group may represent a population of adolescents in whom weight gain would lead to the classic PCO phenotype. Metabolic analyses in these patients will provide further assessment of parameters that affect ovarian dysfunction.

Variation in Ovarian Morphology and Biochemical Markers of Hyperandrogenism in Adolescents with Polycystic Ovary Syndrome

Background: Perimenarchal onset of polycystic ovary syndrome (PCOS), the most common endocrinopathy of the premenopausal years, is increasingly appreciated. In adolescents meeting clinical criteria for PCOS, transabdominal pelvic ultrasonography (TAUS) is often utilized for evaluation of ovarian morphology. While polycystic appearing ovaries (PCO) constitute a diagnostic criterion for PCOS (Rotterdam criteria 2003), it remains to be determined if PCO as assessed by TAUS in adolescents tracks with other diagnostic criteria of PCOS such as biochemical hyperandrogenism.

Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy

Ectopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. To prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. Patients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison's pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison's pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. There were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison's pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. Free intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention.

Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy

BackgroundEctopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. ObjectivesTo prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. MethodsPatients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison's pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison's pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. ResultsThere were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison's pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. ConclusionsFree intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention.

Multifollicular ovaries in female adolescents with cystic fibrosis

To assess hormonal status and morphology of ovaries in cystic fibrosis (CF) adolescents. Prospective study. University teaching hospital. Female adolescents: 18 with CF and 18 normal. Transabdominal pelvic ultrasonography and venipuncture. Hormone profile and ultrasound examination of ovaries and uterus. Levels of LH, LH/FSH, androstenedione, and PRL were significantly higher in the CF adolescents. Levels of sex hormone-binding globulin (SHBG) were significantly lower and had negative correlation with percentage of body fat. Percentage of body fat and body mass index were significantly lower in CF and had significant correlation. Levels of E2, FSH, T, and DHEAS were comparable in the two groups. Ultrasound revealed cysts in eight (44%) of the CF subjects; six of these had LH/FSH >3, and three had been operated for ovarian torsion. Nine out of all of the CF subjects (50%) had DM. No obesity, hirsutism, or acne was observed. The Shwachman score was 87.44 +/- 4.83 and correlated significantly with the percentage of body fat. Multifollicular ovaries were frequent in CF adolescents. Hormone changes characteristic of polycystic ovary syndrome were detected. The low T levels, despite low SHBG, and the absence of hirsutism or acne may be a result of a lower percentage of body fat, disturbances at the pilosebaceous-adipocyte endocrine unit, or mechanical or other causes.

Risk stratification of suspected ectopic pregnancy by transabdominal emergency physician–performed ultrasonography

Study objectives: Many studies have proven the accuracy of transvaginal ultrasonography to exclude an extrauterine gestation (EUG) in patients presenting to the emergency department (ED), but it has its shortcomings in its invasiveness, infection control concerns, and time to obtain. In addition, transvaginal ultrasonography does not include an examination of Morison's pouch for free intraperitoneal fluid, which has been retrospectively associated with ruptured EUG but has not been investigated prospectively. This study evaluates whether emergency physician–performed bedside transabdominal pelvic ultrasonography with examination of Morison's pouch for free fluid can aid in the evaluation of patients with a suspected EUG. Methods: This was a prospective observational study that enrolled consecutive pregnant patients who presented to the ED and for whom there was a suspicion of EUG and intent to obtain imaging by the department of radiology. All patients who presented to the ED with pregnancy and suspicion of EUG were eligible for enrollment. Study participants had a transabdominal pelvic emergency physician–performed ultrasonograph that was classified as an intrauterine pregnancy (IUP) or no definitive IUP (NDIUP) and a Morison's pouch view that was classified as positive or negative for free intraperitoneal fluid. The majority of patients (94%) had subsequent transvaginal ultrasonography performed by radiology. All emergency physician–performed ultrasonographic examinations were recorded in super-VHS in their entirety. Follow-up was attempted for all patients to identify final outcome as IUP or EUG, including the clinical course for all EUGs. Results: From February to December 2003, 218 patients were consecutively enrolled by 48 physicians. Seventy-nine of the emergency physician–performed ultrasonographs were classified as IUPs and 139 as NDIUPs. Average time to complete the emergency physician–performed ultrasonography was 4 minutes 27 seconds. Of the 79 emergency physician transabdominal ultrasonographs classified as IUPs, radiology, according to their transvaginal ultrasonography, classified 72 as IUPs and 1 as NDIUP, and 6 had no formal radiology ultrasonography but were found to have IUPs on final follow-up. Of the 139 emergency physician–performed ultrasonographs classified as NDIUPs, radiology classified 66 as NDIUP (including 16 read as EUGs) and 66 as IUP, and 8 had no formal radiology ultrasonography (4 were thought to have a high likelihood of EUG and went straight to the operating room after the emergency physician–performed transabdominal ultrasonography). Compared with radiology results, sensitivity of emergency physician–performed ultrasonography for IUP was 53% and specificity was 99%. Free fluid in Morison's pouch was identified by emergency physician–performed ultrasonography in 12 patients, 9 of whom underwent immediate operative intervention for EUG. The remaining 3 were found to have IUPs with free fluid caused by another source (likely a ruptured cyst). On final follow-up, there were 170 IUPs, 25 EUGs, and 22 patients lost to follow-up. Of the EUGs, 16 underwent immediate operative intervention. The odds ratio for patients with suspected EUG and positive for free fluid in Morison's pouch for operative intervention compared with that of patients negative for intraperitoneal fluid in Morison's pouch was 85.3 (95% confidence interval 18.9 to 385.5). Conclusion: Transabdominal emergency physician–performed ultrasonography in suspected EUG is specific for IUP, although sensitivity is only 53%, and therefore can safely exclude EUG in a subset of patients. In addition, identification of free fluid in Morison's pouch dramatically increases the odds of operative intervention for EUG.

Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens, and insulin

Study Objective: To evaluate the possible role of inappropriate LH secretion, hyperandrogenism, and hyperinsulinemia in the development of polycystic ovaries (PCO) and the polycystic ovary syndrome. Design: Observational. Setting: General population samples. Participants: 58 adolescents with regular menstrual cycles, 50 with irregular menstrual cycles, and 29 with oligomenorrhea (age 16.7 ± 0.9 years). Interventions: Transabdominal pelvic ultrasonography and vena puncture. Main Outcome Measures: PCO; LH, androstenedione, and testosterone levels; overnight fasting insulin concentrations; and oligomenorrhea. Results: The prevalence of PCO increased significantly with the irregularity of the menstrual cycle pattern, as illustrated by the study, finding PCO in 9% of the girls with regular menstrual cycles, 28% of those with irregular menstrual cycles, and 45% of oligomenorrheic girls. The LH and androgen concentrations were significantly higher in girls with PCO; the insulin levels and the glucose–insulin ratio did not differ when the girls with PCO were compared with girls with normal ovaries. Oligomenorrheic girls with PCO had the highest androgen and LH concentrations; their insulin concentrations and glucose–insulin ratio were in the same range as girls with regular menstrual cycles and normal ovaries; and both their hip and waist girths were wider, although their waist–hip ratio was normal. Conclusions: PCO in adolescents is associated with irregular menstrual cycles, oligomenorrhea, and/or high androgen and LH levels; but no relationship was found with the insulin level or glucose–insulin ratio. Thus, it is doubtful that hyperinsulinemia is an important factor in the development of PCO or polycystic ovary syndrome.

The Value of Transabdominal Pelvic Ultrasonography in Monitoring of Ovulation Induction with Gonadotropins

Seventy-five patients with a total of 306 human menopausal gonadotropin treatment cycles over the period 1984-1989 were analysed retrospectively to evaluate the value of transabdominal pelvic ultrasonography in prevention of complications arising from ovulation induction with human menopausal gonadotropins. There were 60 pregnancies giving a pregnancy rate of 19.6% per cycle. There was positive correlation between the number of follicles > or = 14 mm in mean diameter and the incidence and degree of hyperstimulation (p < 0.005) as well as the incidence of multiple pregnancies (p < 0.01). Ultrasonography is a useful adjunct for monitoring in such a program.

Recurrent female pelvic cancer: assessment with transrectal ultrasonography.

Fifty-two women with symptoms or signs suggesting pelvic recurrence of biopsy-proved pelvic cancer were assessed in a prospective trial by clinical examination, transabdominal pelvic ultrasonography (TAU), computed tomography (CT), and transrectal pelvic ultrasonography (TRU). TRU significantly added to the information from TAU in the measurement of abnormalities on the pelvic sidewalls, and to TAU and CT in the measurement of abnormalities in the central and presacral regions of the pelvis. Results of this preliminary study suggest that TRU may provide information complementary to that from CT in women with suspected recurrence of gynecologic cancer.