Rad

Transvaginal Ultrasound

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Transvaginal Ultrasound, Endovaginal ultrasonography

  • Indications
  1. Fetal Ultrasound or Ectopic Pregnancy evaluation
    1. Early first trimester (before day 42, HCG <6000)
  2. Postmenopausal uterine bleeding
  3. Pelvic mass
  4. Dysmenorrhea
  5. Infertility evaluation
  • Technique
  1. Uterus
    1. Check Cervix with the probe pulled slightly back
    2. Measure Uterine Size in sagittal and coronal views
    3. Identify posterior masses and cul-de-sac fluid
  2. Ovaries
    1. Ovaries are adjacent to the femoral vessels
    2. Identify free fluid near Adnexa
    3. Completely scan ovaries in two planes
    4. Normal ovarian volume: 6-14 cubic cm
  3. Endometrium
    1. Follicular Phase: Endometrium begins to thicken
    2. Ovulation: Triple line seen
    3. Secretory phase: Endometrium echogenic and 8-12 mm
    4. Postmenopausal: Thickness <6-8 mm
  • Efficacy
  1. Postmenopausal Bleeding: Endometrial stripe evaluation
    1. Endometrial Stripe >5 mm considered abnormal
      1. Consider Endometrial Biopsy
    2. Scandinavian Study (n=1168 all with uterine bleeding)
      1. 114 women with Endometrial Cancer by biopsy
      2. No cancer cases in endometrial thickness <4mm
      3. Reference
        1. Karlsson (1995) Am J Obstet Gynecol 172:1488-94 [PubMed]
    3. Japanese study (n=150, 47 with uterine bleeding)
      1. Six patients had Endometrial Cancer
      2. Three cancer patients had 2-4 cm thick endometrium
      3. Reference
        1. Tsuda (1995) Am J Obstet Gynecol 172:1494-5 [PubMed]