In outpatient clinics and, more specifically, within the emergency department, women frequently present for evaluation of pelvic complaints. Fortunately, with increasing knowledge and the advancement of ultrasound, a more thorough assessment can be completed without exposing patients to unnecessary radiation. Transvaginal ultrasound allows providers to obtain valuable information about pelvic organs to aid in the diagnostic discovery of a patient’s complaint such as acute pelvic pain or abnormal vaginal bleeding. To this point, in most cases, gynecologic problems are best imaged using ultrasound. This chapter will focus on performing a gynecologic ultrasound, basic pelvic anatomy, image acquisition using a transvaginal approach, and interpretation of pathology.
KeywordsOvarian cyst Polycystic ovarian syndrome Ovarian torsion Tubo-ovarian abscess Intrauterine device Fibroids
Long axis of uterus. Sagittal view of an anteverted uterus in long axis using transvaginal ultrasound. Note the midline bright white endometrial stripe (MP4 2328 kb)
Pouch of Douglas. Pouch of Douglas is a potential space posterior to the uterus and anterior to the rectum. In this transvaginal sagittal view, note the small amount of fluid posterior to the uterus within the pouch of Douglas (MP4 2241 kb)
Uterus in transverse. Transverse view of a uterus in short axis using transvaginal ultrasound. Note the bright white endometrial stripe within the uterus
Normal ovary. When imaging in a transverse plane, identify each ovary to the right and left of the uterus. Here, a normal ovary is seen with several small follicular cysts visualized as small hypoechoic circles (MP4 2373 kb)
Simple ovarian cyst. In a transverse plane, an ovary is seen on the left side of the screen with a small simple cyst containing anechoic fluid (MP4 703 kb)
Complex ovarian cyst. Complex ovarian cyst containing fluid with varying echogenicity imaged in a transverse plane (MP4 2312 kb)
Ovarian torsion. Large ovarian cyst almost obliterating the normal ovarian architecture in this female with sudden onset unilateral pelvic pain is highly concerning for ovarian torsion (MP4 1942 kb)
Ovary with normal color Doppler. Normal sized ovary with normal color flow as seen in this transvaginal ultrasound using color Doppler (MP4 2299 kb)
Ovary with reduced flow on color Doppler. Ovary with a large ovarian cyst a small amount of flow as seen on color Doppler, concerning for ovarian torsion (MP4 2080 kb)
Tubo-ovarian abscess. Transvaginal ultrasound of the right adnexa in transverse plane demonstrating multiple varying sized complex cystic appearing structures consistent with tubo-ovarian abscess (MP4 2330 kb)
IUD Placement. Transvaginal ultrasound of the uterus in a sagittal plane demonstrating an intrauterine pregnancy with an IUD in place. Note the echogenic IUD with posterior shadowing followed by a gestational sac containing a yolk sac and fetal pole (MP4 2449 kb)
Uterine fibroid. Transvaginal ultrasound of the uterus in a sagittal plan showing a small uterine fibroid located in the myometrium posterior to the uterine stripe (MP4 2267 kb)
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