Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography

During a 25-month period, 193 women with the clinical diagnosis of suspected ectopic pregnancy had transabdominal and endovaginal sonograms. Most had quantitative determinations of serum human chorionic gonadotropin (HCG). Endovaginal sonography was diagnostic of ectopic pregnancy in 23 (38%) of the 60 patients with surgically proved ectopic pregnancies: transabdominal sonography was diagnostic in 13 patients (22%). All 83 intrauterine pregnancies were identified with endovaginal sonography, compared with 34 identified with transabdominal sonography. Endovaginal sonography was somewhat more helpful in the diagnosis of missed abortion and blighted ovum. Eighty endovaginal sonograms were classified as indeterminate as compared with 141 transabdominal studies. This indeterminate group included patients with complete abortions, ectopic pregnancies without sonographic evidence of an extrauterine gestation, incomplete abortions, and patients with subsequent negative serum levels. As in prior reports, endovaginal sonography was superior to transabdominal sonography in the evaluation of suspected ectopic pregnancies. Overall, endovaginal sonography was diagnostic in 113 patients, whereas transabdominal sonography was diagnostic in 52 patients. The finding of an extrauterine fetal pole or embryo was diagnostic for an ectopic pregnancy. Pelvic fluid, the appearance of the endometrium, and a single positive serum HCG determination were not helpful in making the diagnosis of ectopic pregnancy.     

Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography

OBJECTIVE. Overlying intestinal gas often impairs transabdominal sonographic assessment of the lower sigmoid colon. The aim of this study was to investigate the usefulness of transrectal sonography in addition to transabdominal sonography for the evaluation of sigmoid diverticulitis. SUBJECTS AND METHODS. Eighty-six consecutive patients with clinically suspected acute sigmoid diverticulitis were referred for transabdominal sonography as the initial imaging method. In 46 patients, transrectal sonography was performed in addition to transabdominal sonography if pain was localized to the mid lower abdomen and if a disease process could not be visualized or could be only partially visualized on transabdominal examination. An end-firing 5-9-MHz endocavitary probe was used for transrectal sonography. RESULTS. Thirty-four of 50 patients with a final diagnosis of sigmoid diverticulitis underwent both transabdominal and transrectal sonography. In 20 patients, transrectal sonography showed relevant additional information: six diagnoses of diverticulitis were established on transrectal sonography alone. Transrectal sonography revealed one perforation, five abscesses, and three fistulous complications that were not shown on transabdominal sonography. In the remaining five patients, correct diagnoses were supported on transabdominal examinations, but only transrectal sonography could show an inflamed diverticulum. In 10 patients, transrectal sonography revealed signs of diverticulitis but no relevant information in addition to the results from transabdominal sonography. Four false-negative and two false-positive results were revealed with transrectal sonography. CONCLUSION. Transrectal sonography is accurate for confirming clinically suspected acute colonic diverticulitis when the lower sigmoid colon is affected. It helps avoid false-negative results and defines the severity of disease in the lower sigmoid colon better than transabdominal sonography alone. Transrectal sonography can increase the sensitivity of sonography for diagnosing sigmoid diverticulitis.     

Ectopic pregnancy: Value of transabdominal sonography without deliberate bladder distention

We reviewed 19 consecutive patients with ectopic pregnancy in whom pelvic sonography demonstrated findings highly predictive of the diagnosis. The correct diagnosis was established by transabdominal sonography without attempting bladder distention in 12 patients (63%); the bladder was full in only one patient. Transabdominal sonography performed without waiting for the bladder to fill and thus with no delay or patient discomfort can establish the presence of ectopic pregnancy and obviate the need for transvaginal sonography in a substantial proportion of patients in whom the diagnosis can be made sonographically. In patients at risk for ectopic pregnancy, we recommend that transabdominal sonography without waiting for bladder distention be attempted before transvaginal sonography is performed.     

Transvaginal and transabdominal sonography: prospective comparison

Transvaginal (TV) and transabdominal (TA) sonography were compared in a prospective study. A total of 230 examinations (126 pelvic, 104 pregnancy) were performed on 215 patients, ranging in age from 14 to 80 years. The improved anatomic detail on TV scans yielded new information in 138 (60%) examinations and better visualization of pelvic structures in 51 (22%) examinations. There was no important difference in diagnostic information provided by the two imaging modalities in 36 (16%) cases, and TV images were worse in five (2%). The clinical diagnosis was altered on the basis of TV sonographic findings in 54 (24%) cases and confirmed with certainty in 166 (72%). Diagnostic problems posed by TA scanning were not resolved by TV scanning in ten (4%) instances. Statistical analysis indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac contents (P less than .005), detection of fetal heart motion (P less than .001), and evaluation of the endometrial canal in the retroverted or retroflexed uterus (P less than .001). TV scanning was significantly better than TA scanning in visualization of the ovaries in patients with uterine leiomyomas (P less than .005) but not significantly better in peri- and postmenopausal patients (P greater than .05).     

Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses

In a retrospective study, we compared transvaginal sonograms with transabdominal sonograms in 67 women referred for evaluation of palpable pelvic masses. The diagnoses included ovarian cyst (27), endometrioma (12), complex cyst (four), dermoid (three), infection (three), ovarian malignancy (two), and uterine fibroid (three). The final diagnosis was made surgically in 41 patients (61%) and by a combination of sonographic and clinical correlation in the remaining patients. More information about the internal architecture or anatomy of the mass was provided by the transvaginal images than by the transabdominal scans in 51 (76%) of the patients. Transabdominal sonography did not provide more diagnostic information in any of the patients examined. Transvaginal sonography was helpful in obese patients, in those with a large amount of bowel gas, and in those unable to achieve adequate bladder filling. Six simple cysts and four complex pelvic masses were identified solely on transvaginal sonograms. The results suggest that transvaginal sonography has considerable advantages over conventional transabdominal sonography in the evaluation of pelvic masses in women.     

Gynecologic imaging: comparison of transabdominal and transvaginal sonography

The sonographic findings in 200 patients who underwent concurrent transabdominal and transvaginal pelvic ultrasound were reviewed. The sonographic techniques were compared for image quality, completeness of anatomic detail depicted, and unique diagnostic information. Transvaginal image quality was better in 79%-87% of scans; transabdominal image quality was better in 3%-5% of scans; images of both techniques were equally good in 10%-18% of scans. The techniques provided equivalent diagnostic information in 60%-84% of cases. Transvaginal sonography was particularly helpful when exclusion of ectopic pregnancy was the clinical concern. Individual organs and fine structures were better seen transvaginally, but the regional survey offered by the transabdominal full-bladder approach remains necessary to provide anatomic orientation, particularly when the patient has not been studied previously.     

Comparison of transvaginal and transabdominal sonography in the detection of early pregnancy and its complications

Ninety women with a positive pregnancy test and signs and symptoms of threatened abortion or ectopic pregnancy had endovaginal and abdominal sonography in order to compare the value of the two techniques for the detection of gestational abnormalities. Either a normal delivery occurred or surgical and/or pathologic confirmation of the diagnosis was available in all cases. Fifty-five women had normal intrauterine pregnancies, 22 had ectopic pregnancies, seven had blighted ova, and six had missed abortions. All 55 normal intrauterine pregnancies were detected by endovaginal sonography, while only 11 (20%) were diagnosed by transabdominal sonography. The yolk sac, fetal pole, and fetal heart motion were seen as early as 34 days from the last menstrual period with endovaginal sonography, compared with 42 days with transabdominal sonography. Fetal heart motion was detected with endovaginal sonography in fetal poles with a crown-rump length of 3 mm or greater, whereas the fetal pole had to be at least 6 mm before fetal heart motion could be detected with the transabdominal technique. In the 22 ectopic pregnancies, a specific diagnosis of an extrauterine sac containing a fetal pole with heart motion or yolk sac was possible in three cases with the endovaginal technique, but it was not possible in any case with transabdominal sonography. Both techniques showed that each of the seven patients with final diagnosis of blighted ova had a gestational sac that was 1.7 cm or larger without visualization of the fetal pole or yolk sac. All six missed abortions were detected by endovaginal sonography, but only three were diagnosed on transabdominal sonograms. Our findings show that endovaginal sonography is more sensitive than transabdominal sonography in the detection of early pregnancy and its complications.     

经腹超声与经阴道超声双向检查在早期妊娠诊断中的价值

目的 探讨经腹超声和经阴道超声在早期妊娠检查中的应用价值,以便寻找出早期妊娠的最佳检测方法.方法 选择停经31～42天,且HCG(人绒毛膜促性腺激素)为阳性或弱阳性,疑似早期妊娠的122例患者,年龄19～40岁,平均27.6岁,均行经腹超声和经阴道超声检查,分别观察子宫、妊娠囊、胚芽、胎心的情况,针对两次的检测结果进行比较.结果 122例患者中,经腹超声检测出妊娠囊、卵黄囊91例,检出率达到74.6％;经阴道超声检测出妊娠囊、卵黄囊120例,检出率达到98.4％.经腹超声检测出胚芽者58例,经阴道超声检测出胚芽者80例,经阴道超声与经腹超声相比可以更早检测出胚芽.在同时检测出胚芽的52例中,经腹超声的胎心检出率为23.1％,经阴道超声的胎心检出率为53.8％,经阴道超声与经腹超声相比胎心检出时间可以提前1周.结论 经阴道超声检测早期妊娠的灵敏度和准确性高于经腹超声,经腹超声和经阴道超声相结合是临床检测早期妊娠安全、准确的方法.     

Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography

OBJECTIVE: We prospectively evaluated transabdominal and transvaginal sonographic findings of patients with pelvic congestion syndrome and compared them with those of healthy volunteers. SUBJECTS AND METHODS. We examined 32 patients with pelvic congestion syndrome and 35 control subjects. Using transabdominal sonography, we evaluated the ovarian veins for diameter and flow direction, presence of pelvic varicocele, diameter of the pelvic veins, change of the duplex waveform during the Valsalva's maneuver, volume of the uterus, and presence of polycystic changes in the ovaries. We compared and statistically analyzed each parameter in the pelvic congestion syndrome group and in the control group. RESULTS: The mean (+/- SD) diameter of the left ovarian vein was 0.79 +/- 0.23 cm in the pelvic congestion syndrome group and 0.49 +/- 0.15 cm in the control group (p = 0.000). Reversed caudal flow in the left ovarian vein was present in 22 of 22 patients and in four of 16 control subjects. Pelvic varicoceles were present in all patients with pelvic congestion syndrome and in six control subjects. The mean diameter of the left pelvic vein was 0.68 +/- 0.21 cm in the pelvic congestion syndrome group and 0.42 +/- 0.19 cm in the control group; the mean diameter of the right pelvic vein was 0.64 +/- 0.24 cm in the pelvic congestion syndrome group and 0.35 +/- 0.14 cm in the control group (p = 0.000). Polycystic changes of the ovary were present in 13 patients with pelvic congestion syndrome (40.6%) and four control subjects (11.4%). CONCLUSION: Sonographic findings of pelvic congestion syndrome were dilated left ovarian vein with reversed caudal flow, presence of varicocele, dilated arcuate veins crossing the uterine myometrium, polycystic changes of the ovary, and variable duplex waveform during the Valsalva's maneuver. Combined transabdominal and transvaginal sonography are potentially useful as a noninvasive screening tool for determining which patients with chronic pelvic pain may benefit from selective ovarian venography and transcatheter embolization.     

经阴道与经腹超声诊断输卵管妊娠的对比研究

目的探讨经阴道彩超对输卵管妊娠的诊断价值。方法40例临床疑为宫外孕的患者于术前分别用经腹扫描（TAS）和经阴道扫描（TVS）进行超声诊断，根据手术病理结果,将2种超声扫描方法对输卵管妊娠的超声表现和诊断结果进行自身对照分析，分别行χ2检验。结果TAS组显示包块27例（显示率27/40），TVS组显示包块36例（显示率36/40）(χ2=7.364，P<0.05)；TAS组超声诊断结果与手术病理结果符合23例（符合率23/40），TVS组符合34例（符合率34/40）(χ2=7.384，P<0.05)。结论TVS对输卵管妊娠的早期显示率及诊断正确率明显优于TAS。     

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.     

Diagnosis of symptomatic intestinal metastases using transabdominal sonography and sonographically guided puncture

OBJECTIVE. We studied the sonographic findings of symptomatic intestinal metastases and the use and safety of subsequent sonographically guided 22-gauge fine-needle aspiration or 18-gauge core biopsy. CONCLUSION. Symptomatic intestinal metastases can be diagnosed by transabdominal sonography. Extensive hypoechoic segmental bowel wall thickening with loss of stratification and intussusception can be observed. Sonographically guided fine-needle aspiration or 18-gauge core biopsy performed at the end of the examination allows definite diagnosis and is a safe procedure.     

Color-coded Doppler sonography in pregnancy

Recently the advantages of angiodynography have been reported for different purposes. The goal of this study was to find out the validity of colour flow mapping for obstetric patients. Additionally, we compared the obtained results with those obtained by conventional pulsed Doppler measurement. 30 women with an uneventful pregnancy were investigated. Angiodynography enabled us to depict a selected vessel quicker and to visualise the course of the investigated vessel. Furthermore, the new method of colour flow mapping and subsequent pulsed Doppler measurement results in visual vessel recognition of fetal and maternal vasculature and therefore subsequent Doppler measurement is also possible in small vessels. This method could be valuable for the diagnosis of high-risk pregnancies.