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Modified Ultrasonographic Techniques

  • Simone FerreroEmail author
  • Umberto Leone Roberti Maggiore
  • Fabio Barra
  • Carolina Scala

Abstract

Nowadays, transvaginal ultrasonography (TVS) is the first-line investigation in women with suspicion of deep infiltrating endometriosis (DE). However, TVS diagnostic accuracy is dependent on the experience of the sonographers and may be improved by distending the vagina and/or rectum with saline solution or gel. These modified ultrasound techniques may be useful when the findings of TVS are inconclusive or when the sonographers have limited experience in the diagnosis of DE. This chapter will describe the most commonly modified ultrasound techniques used in the diagnosis of DE including tenderness-guided transvaginal ultrasonography (tg-TVS), sonovaginography (SVG), rectal water contrast transvaginal ultrasonography (RWC-TVS), and three-dimensional rectosonography (3D-RSG).

Supplementary material

Video 14.1

RWC-TVS shows a mild stenosis (≥50%) of the rectal lumen due to endometriosis. The endometriotic nodule is hypoechoic and has blurred margins. A thinner section (“tail”) is noted at one end. During surgery, nodule shaving was performed (MOV 24888 kb)

Video 14.2

RWC-TVS shows a significant intestinal stenosis (≥50%) of the rectal lumen due to endometriosis. The endometriotic nodule, located on the anterior rectum, causes a thickening of the hypoechoic muscularis propria. The nodule is hypoechoic and has blurred margins. A thinner section (“tail”) is noted at one end. The nodule infiltrates the rectal submucosa and mucosa. The patient was treated by segmental resection (Fig. 14.13) (MOV 31786 kb)

Video 14.3

Sonovaginography with gel. An assistant holds the bottle of gel with its mouth facing downward. The syringe is introduced into the lower part of the inverted bottle. The plunger is held steady in position, and the barrel (outer sleeve) is slowly pushed farther up into the inverted bottle of gel to fill the syringe with 20 mL of gel [6] (MOV 132000 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Simone Ferrero
    • 1
    • 2
    Email author
  • Umberto Leone Roberti Maggiore
    • 1
    • 2
  • Fabio Barra
    • 1
    • 2
  • Carolina Scala
    • 1
    • 2
  1. 1.Academic Unit of Obstetrics and GynecologyOspedale Policlinico San MartinoGenoaItaly
  2. 2.Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of GenoaGenoaItaly

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