Transvaginal Sonographic Appearance Research Articles

Unexpected Findings During Evaluation of Acute Pelvic Pain With Transvaginal Sonography.

Transvaginal sonography is the first-line imaging modality used to evaluate acute female pelvic pain in the emergency setting because of its accessibility, lack of ionizing radiation, and excellent ability to identify reproductive tract disorders. Although the intent of transvaginal sonography is to evaluate the reproductive organs, imaging of adjacent pelvic structures is an important part of every transvaginal sonographic examination. Gastrointestinal, urologic, and vascular disorders incidentally scanned on transvaginal sonography may explain the pain for which the examination is being performed. In such cases, transvaginal sonography may play an important role in the diagnostic process if the clinician is aware of the transvaginal sonographic appearance of these entities.

Outcome Prediction for Treatment of Tubal Pregnancy Using an Intramuscular Methotrexate Protocol

The purpose of this study was to determine the outcome predictors of intramuscular methotrexate therapy for tubal pregnancy. This retrospective study was approved by our Institutional Review Board. Fifty-five consecutive women (mean age, 31 years; range, 18-45 years) who were treated with intramuscular methotrexate therapy for tubal pregnancy were retrospectively reviewed. Clinical data (maternal age, gestational age, and serum beta-human chorionic gonadotropin [beta-hCG] level) and transvaginal sonographic findings (size, gross appearance, presence of a gestational product or heartbeat, and amount of the fluid collection) were assessed as potential predictors of the treatment outcome. The Fisher exact test was used for categorical variables, and the Wilcoxon signed rank sum test was used for continuous variables. Treatment failure was defined as the need for surgical intervention. Women with successful treatment differed from women with unsuccessful treatment with respect to the serum beta-hCG level, the gross appearance of tubal pregnancy, and the presence of a gestational product such as a yolk sac or embryo (P <.001; P = .01; and P =.008, respectively). All of the tubal pregnancies with a gestational product appeared as a tubal ring on transvaginal sonography. A high serum beta-hCG level of greater than 2390 mIU/mL and a transvaginal sonographic appearance of a tubal ring were the important predictors associated with failure of intramuscular methotrexate therapy for tubal pregnancy. Measurement of the serum beta-hCG level and evaluation of the transvaginal sonographic appearance of tubal pregnancy are helpful for predicting treatment outcomes in women who receive intramuscular methotrexate therapy for tubal pregnancy.

Transvaginal sonographic features of peritoneal carcinomatosis

Peritoneal carcinomatosis involves the dissemination of intra-abdominal tumor tissue often associated with gynecological malignancies. The objective of this study was to describe the transvaginal sonographic appearance of this condition. The data of 60 patients with surgically and histologically proven peritoneal carcinomatosis were analyzed. Transvaginal sonograms performed within 7 days of admission to the operating theater were re-evaluated in order to identify the sonographic features associated with peritoneal carcinomatosis. Carcinomatosis was revealed in 53/60 cases (88%) by the presence of hypoechoic nodules attached to the peritoneum and visible on transvaginal sonography (TVS). The pouch of Douglas was the site most frequently involved. Power Doppler sonography showed the presence of blood vessels in 48 (91%) of these metastases. Ascites was found in 50 (83%) women. An adnexal mass suggestive of being the primary tumor was present in only 41 women (68%). Peritoneal carcinomatosis has typical features on TVS and, in the vast majority of cases, its genital origin can be correctly hypothesized. Power Doppler sonography strengthens the diagnosis by showing vascularity of the peritoneal implants. In a patient with a known pelvic malignancy or whenever peritoneal carcinomatosis is suspected, TVS can give useful information in order to better assess the presence and extension of metastatic nodules within the abdominal cavity.

Transvaginal Sonographic Appearance of Peritoneal Pseudocysts

Transvaginal Sonographic Appearance of Peritoneal Pseudocysts

Transvaginal sonographic appearance of thrombosed uterine arteries after uterine artery embolization: the "white snake" sign.

The aim of this prospective study was to describe the appearance of thrombosed uterine arteries on transvaginal sonography performed after uterine artery embolization (UAE) and to assess the prognostic value of the "white snake" sign with regard to symptomatic outcome at 12 months. Patients who underwent UAE from January 1, 1999, to July 31, 2000, for the treatment of symptomatic leiomyomas were included in the study. Transvaginal sonography was performed before and at 3, 6, and 12 months after UAE. Patients graded the severity of their symptoms on a scale from 1 to 5, with 1 being the least and 5 the most severe, before and at 12 months after the procedure. The Wilcoxon rank-sum test was used to determine correlations between severity of symptoms and presence of the white snake sign; a p value of less than 0.05 was considered significant. During the study period, UAE was performed in 19 patients with a mean age of 41 years (range, 32-48 years). UAE was technically successful in all patients. Eighteen patients (95%) reported symptomatic improvement at 12 months: 8 patients (42%) by 4 severity-scale points, 5(26%) by 3 points, and 5 (26%) by 2 points. The 1 patient who did not experience improvement had undergone a hysterectomy at 4 months after the UAE. At the 3-month follow-up, transvaginal sonography demonstrated a tortuous echogenic structure in the adnexa (the white snake sign) in all patients; the finding was still apparent in 10 patients at 6 months but in only 2 patients at 12 months. A direct correlation was found between persistence of the white snake sign and the degree of symptomatic improvement at 6 months (p=0.04) but not at 12 months (p=0.08). After UAE, a thrombosed uterine artery appears on transvaginal sonography as an echogenic tortuous structure in the adnexa. Persistence of this white snake sign at 6 months after UAE may suggest a more favorable symptomatic outcome.

Transvaginal sonographic appearance of the cerebellar vermis at 14–16 weeks' gestation

Ultrasound in Obstetrics & GynecologyVolume 19, Issue 2 p. 208-209 Letter to the EditorFree Access Transvaginal sonographic appearance of the cerebellar vermis at 14–16 weeks' gestation M. Ben-Ami, Corresponding Author M. Ben-Ami [email protected] Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelDepartment of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorY. Perlitz, Y. Perlitz Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorD. Peleg, D. Peleg Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author M. Ben-Ami, Corresponding Author M. Ben-Ami [email protected] Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelDepartment of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorY. Perlitz, Y. Perlitz Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorD. Peleg, D. Peleg Department of Obstetrics and Gynecology, Poriya Hospital, Tiberias, M.P.O. Lower Galilee, 15280, Israel affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author First published: 12 December 2002 https://doi.org/10.1046/j.0960-7692.2001.00476.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume19, Issue2February 2002Pages 208-209 RelatedInformation

Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar.

To apply an existing diagnostic imaging test (saline infusion sonohysterography) to characterize the "filling defect" of a previous cervical cesarean delivery scar in the nonpregnant uterus. Forty-four patients with histories of cesarean delivery who underwent saline infusion sonohysterography for a variety of gynecologic indications were included. During the procedure, the area below the bladder recess was examined using transvaginal sonography. A filling defect or "niche" was defined as a triangular anechoic structure at the presumed site of a previous cesarean delivery scar. The depth of the niche was measured. Uterine size, the presence of fibroids and polyps, and the number of previous cesarean deliveries were noted. All patients had a niche indenting the anterior uterine-cervical wall. The mean +/- SD depth of the niche was 6.17 +/- 3.6 mm. There was no correlation between the number of cesarean deliveries and the depth of the niche. Thirty-six percent of our patients had fibroids, and 18% had endometrial polyps. Saline infusion sonohysterography was able to detect filling defects in women who previously had cesarean deliveries. We hope that by focusing our attention on the transvaginal sonographic appearance of the detectable uterine scar (niche) with or without the use of saline infusion sonohysterography in the nonpregnant uterus, it will train our eyes to look for the scar in the pregnant uterus. In addition, our study patients had a high prevalence of abnormal uterine bleeding. The role of the cesarean delivery scar in women with unscheduled bleeding needs to be further evaluated.

Transvaginal sonographic evaluation of endometrial polyps.

The purpose of this study was to correlate the sonographic and histologic findings of focal lesions of the endometrium as depicted by transvaginal sonography. Sixteen focal endometrial masses were encountered during an 8 month period. The transvaginal sonographic appearance was correlated with findings at surgery or hysteroscopy. All uniformly hyperechoic endometrial masses were benign endometrial polyps. Five heterogeneous lesions were complicated endometrial polyps; one of these showed a focus of endometrial carcinoma. Four small and uniformly hypoechoic lesions were all prolapsed submucosal leiomyomata. Our results showed that a well-defined, uniformly hyperechoic mass within the endometrial cavity is most suggestive of a benign endometrial polyp. Larger masses with a heterogeneous appearance are nonspecific and warrant further evaluation and biopsy.

Laparoscopic management of adnexal cystic masses in postmenopausal women.

To evaluate laparoscopic treatment of postmenopausal women with an adnexal cystic mass predicted to be benign. Selection criteria were transvaginal sonographic appearance other than a complex cyst and a normal serum CA 125 level. During the period May 1988 to June 1993, 55 women fulfilled the criteria and underwent operative laparoscopy. During the same period, 75 postmenopausal women underwent exploratory laparotomy for an adnexal cystic mass that was complex in appearance or associated with elevated serum CA 125. Laparoscopic bilateral oophorectomy was performed in all 55 women. All had benign masses (positive predictive value 100%). Malignant tumors were found in 23 of the 75 women undergoing laparotomy (negative predictive value 30.7%). There was no significant difference in size of the tumors between women undergoing laparoscopy or laparotomy. Because of its safety and efficacy, laparoscopic management is the preferred procedure in postmenopausal women with a non-complex adnexal mass and a normal CA 125 level.

Transvaginal sonographic appearance of hemorrhagic functional ovarian cysts and their spontaneous regression

To obtain information on the characteristic feature of transvaginal sonograms of hemorrhagic functional ovarian cysts (HFOCs) and their natural course. Thirty-four cases of suspected HFOC based on our tentative criteria were ultrasonically followed-up for 3 months. After the study period, the sonographic findings and their changes with time were analyzed. Twenty-four cases were clinically diagnosed as HFOCs, as the masses disappeared naturally. At the first examination, 5 cases (20.8%) showed a diffuse echogenic pattern which seems to consist of a blood clot, 9 (37.5%) were mixed pattern with a clearly demarcated solid part, 3 (12.5%) were hyperechoic sponge-like reticular pattern and 7 (29.2%) were cysts including vague echo inside which looked cotton-like. Seven masses (29.2%) disappeared within 2 weeks and the remaining had a different sonographic appearance with time until they disappeared finally within 8 weeks. HFOCs show the characteristic changes in transvaginal sonographic appearance and can be diagnosed by short-term follow-up.

Transvaginal sonographic appearance of endometriomata: spectrum of findings.

The spectrum of transvaginal sonographic findings was evaluated in 37 surgically proved endometriomas. Sonographic features assessed included lesion size, acoustic enhancement, wall thickness, wall contour, presence of a fluid-fluid level, and presence of internal echoes. A very characteristic finding seen in 31 (82%) cases is the presence of a homogeneous hypoechoic "carpet" of low-level echoes. This may be present diffusely or in one or several loculations of a multiloculated cystic mass. We consider this finding characteristic of an endometrioma, although not pathognomonic, as on occasion we have encountered other pathologic conditions that have the same appearance.

Hair as a sonographic marker of ovarian teratomas: improved identification using transvaginal sonography and simulation model.

An in vitro sonographic model was developed to simulate the transvaginal sonographic appearance of hair-containing cystic teratomas of the ovary. Two groups of patients with ovarian teratomas were compared: group A--consisting of 32 patients scanned before the simulation model was used, and group B--consisting of 25 patients in whom the diagnosis of hair-containing ovarian teratomas was made after the simulation model experience. The positive predictive value of transvaginal sonography in correctly diagnosing this type of tumor was 27/32 (84%) in group A and 25/25 (100%) in group B. By using this simple in vitro simulation model, the preoperative diagnosis of ovarian cystic teratomas by transvaginal sonography was made very accurate, enabling prospective planning of the type of operation and its timing.