Consider ultrasound first for imaging the female pelvis

Benacerraf, Beryl R.; Abuhamad, Alfred; Bromley, Bryann; Goldstein, Steven R.; Groszmann, Yvette; Shipp, Thomas; Timor‐Tritsch, I. E.

doi:10.1016/j.ajog.2015.02.015

Cited by 51 publications

(23 citation statements)

References 31 publications

(39 reference statements)

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“…9,10 Moreover, transvaginal ultrasound can help detect the origin and fixity of the endometrioma lesion by gently pushing it to show whether there is sliding against the pelvic organs to assess its fixity to these structures. 11 The similar features were observed in present study in 12 cases of endometriosis ( Figure 6) and in one case, the tiny echogenic focus was picked up on gray scale USG ( Figure 7). We have classified all these lesions into ugly lesions due to in homogenous internal contents.…”

Section: Endometriosis/endometriomasupporting

confidence: 88%

Simple vs ugly adnexal lesions: is ultrasonography alone good enough?

Chauhan¹,

Mathur²

2019

Int J Res Med Sci

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Background: Ultrasound (USG) is easily available and effective imaging modality for adnexal lesions. A simple looking lesion on ultrasound is usually benign and an ugly looking adnexal lesion is either benign or malignant. This study aims to evaluate the varied appearance of simple and ugly benign adnexal lesions on USG and to find out any additional role of colour Doppler in such suspected benign lesions. The confirmation of diagnosis was done either by follow up appearance of lesions on USG or by histopathological evaluation.Methods: A total of 55 consecutive female patients with age between 18 to 50 years were enrolled in this prospective cross sectional study. USG and colour Doppler for all the lesions were done. The patients found to have malignant lesions on histopathological examination, were later excluded from the analysis. Follow up USG was done for all the cases. Those cases wherein there was no resolution of lesions even after 08 weeks, were given an option to undergo laparoscopy as next management step.Results: Out of 50 benign adnexal masses, 88% masses were ovarian in origin and 12% were tubal masses. Ovarian masses included hemorrhagic cysts, endometriosis, simple cysts, serous cystadenomas and ovarian dermoid. All extra-ovarian masses were hydrosalpinx. Colour Doppler did not add any additional finding. Some of the patients underwent diagnostic laparoscopy followed by excision of masses in majority of them.Conclusions: Benign adnexal lesions can have varied appearance ranging from simple to ugly on USG. Ultrasonographic features of benign lesions on USG can be appreciated very well even without further use of colour Doppler or cross sectional imaging. Follow up USG remains key modality for benign adnexal masses in absence of MRI.

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Section: Endometriosis/endometriomasupporting

confidence: 88%

Simple vs ugly adnexal lesions: is ultrasonography alone good enough?

Chauhan¹,

Mathur²

2019

Int J Res Med Sci

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“…Concerns about imaging modality can arise when attempting to characterize adnexal masses. CT has shown to help discern adhesions and adnexal sidedness in one study [5]; however discomfort also arises with exposure of the patient to ionizing radiation from CT scans, unlike ultrasound [6]. In this study, dual imaging did not increase the ability to correctly identify laterality, and even between studies there was low concordance.…”

Section: Discussionmentioning

confidence: 52%

Concordance of adnexal mass laterality: from preoperative imaging to surgical pathologic findings

Benoit¹

2020

EJGO

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Patients with pelvic masses present with numerous symptoms to include: pain, bloating, pelvic pressure, changes in bowel or bladder habits, and abdominal distention. Imaging usually follows to elucidate etiology. In the United States, it is estimated that there is a 5-10% lifetime risk for women undergoing surgery for a suspected ovarian neoplasm [1]. When masses are identified, surgery is often recommended. Consent forms have become stricter as patient safety concerns for wrong site and wrong side surgeries have increased. Preoperative specified laterality with skin marking or side-banding prior to surgical invention has been recommended to potentially improve patient outcomes. The present authors undertook this study to evaluate concordance of laterality between imaging and surgical findings. Materials and Methods All 705 patients from a single practice sub-specialty provider were reviewed from January 2015 to October 2017. Admission diagnosis on 666 surgical candidates was complete, 285 patients with a diagnosis of pelvic or adnexal mass were identified, and 280 had final data for review. All patients had surgery within two weeks of subspecialty consultation. Data was abstracted and variables for review included: age, imaging study (ultrasound, CT, MRI) imaging dimensions, imaging laterality, pathologic findings to include histology, pathologic dimensions, and surgical laterality. Volume was attempted to be calculated for both imaging and pathologic data. Three-point data was not available in the majority of imaging studies and pathology reports, therefore the largest dimension recorded had to be used as the final data-point. The authors performed subset analyses of patient age, imaging modality, concordance of imaging modalities within themselves, effect of mass size, and a cancer diagnosis and compared these variables to surgical findings. Data was entered into Excel. Statistical analysis was performed using Graphpad 2018 and Socscistatistics 2018. A p value of ≤ 0.05 was considered significant. All tests were two-tailed and confidence intervals (CI) were set at 95%. IRB approval was requested from the Group Health Research Institute and it was determined that this review was exempt on June 16, 2017 as a Quality Improvement project.

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“…Magnetic resonance imaging (MRI) defecography (MRId) can provide morphological and functional images of the pelvic oor structures with good contrast with soft tissue, but patients with metal pacemakers and intrauterine contraceptive devices (IUDs) are contraindicated to this examination [6] . Benacerraf et al [7] stated that three-dimensional ultrasonography imaging is the rst choice for the study of the uterus, endometriosis and ovaries in women. Three-dimensional ultrasonography can simultaneously display three cross-sections (sagittal, transverse and coronal sections) that are perpendicular to one another to obtain a complete three-dimensional image of the pelvic hiatus.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional ultrasonography study of female defecation disorder caused by changes of the puborectalis muscle

Zhang

Liu

Wang³

et al. 2019

Preprint

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Objective To investigate the correlation between pelvic floor dyssynergia-type constipation and the puborectalis muscle using three-dimensional ultrasonography. Methods Eighty-seven patients with pelvic floor dyssynergia-type constipation (observation group) and 87 healthy volunteers (control group) were enrolled in this study. Three-dimensional ultrasonography of the pelvic floor was performed on patients and healthy volunteers in a lithotomy position at rest and during straining and squeezing. The three-dimensional reconstructed sonogram was analysed to determine the puborectalis angle and puborectalis thickness at the 6 o’clock position (patients in a lithotomy position). Results (1) The puborectalis angles of the observation and control groups were not significantly different at rest [(85.664 ± 1.926)°, (85.813 ± 1.500)°] and during squeezing [(87.478 ± 2.125)°, (86.960 ± 1.751)°] (P > 0.05) but were significantly different when straining [(80.389 ± 2.268)°, (94.382 ± 1.540)°] (P < 0.05). The difference in the puborectalis angles of the two groups between rest and straining [(5.275 ± 1.236)°, (-8.569 ± 1.209)°] was statistically significant (P < 0.05). (2) The puborectalis thickness of the observation and control groups was not significantly different at rest ([3.994 ± 0.128) mm, (3.983 ± 0.091) mm] and during anal squeezing [(4.082 ± 0.154) mm, (4.126 ± 0.113) mm] (P > 0.05) but was significantly different when straining [(4.630 ± 0.199) mm, (4.296 ± 0.121) mm] (P < 0.05). The differences in the puborectalis thickness at rest and during straining in the observation and control groups were (-0.636 ± 0.217) mm and (-0.316 ± 0.089) mm, respectively, resulting in a statistically significant difference between the two groups (P < 0.05). Conclusion The puborectalis angle in patients with pelvic floor dyssynergia-type constipation was smaller than that in healthy volunteers during straining. The puborectalis thickness at the 6 o’clock position with the patient in a lithotomy position in patients with pelvic floor dyssynergia-type constipation was larger than that in healthy volunteers. Moreover, larger differences between rest and straining are associated with a more severe degree of constipation. Project funding Natural Science Foundation of Shandong (ZR2012HM086)

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Consider ultrasound first for imaging the female pelvis

Cited by 51 publications

References 31 publications

Simple vs ugly adnexal lesions: is ultrasonography alone good enough?

Simple vs ugly adnexal lesions: is ultrasonography alone good enough?

Concordance of adnexal mass laterality: from preoperative imaging to surgical pathologic findings

Three-dimensional ultrasonography study of female defecation disorder caused by changes of the puborectalis muscle

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