Sonographic and Doppler Evaluation of the Female Pelvis

LMP

Date of last menstrual period for assessment.

Gravidity

Number of times a woman has been pregnant.

Parity

Number of pregnancies carried to viable gestation.

Hormone regimen

Hormonal treatments affecting pelvic health.

Pelvic examination

Clinical assessment of pelvic organs.

Transabdominal approach

External ultrasound scanning across the abdomen.

Transvaginal approach

Internal ultrasound examination via the vagina.

Uterine size

Measured dimensions of the uterus.

Endometrium

Inner lining of the uterus, analyzed for thickness.

Myometrium

Muscular layer of the uterus, evaluated for masses.

Cervix

Lower part of the uterus, assessed for dimensions.

Cul-de-sac

Space in the pelvis evaluated for fluid or masses.

Ovarian size

Measured by length and AP dimensions.

Ovarian volume

Calculated from ovarian dimensions.

Sonographic technique

Methodology for performing ultrasound examinations.

Mass characterization

Features to assess when a mass is found.

Location of mass

Determines if mass is uterine or extrauterine.

Size of mass

Overall dimensions of the detected mass.

External contour

Shape and borders of the mass.

Internal consistency

Composition of the mass: cystic or solid.

Pelvic ultrasound protocol

Standardized steps for conducting pelvic ultrasound.

Adnexa

Refers to ovaries and fallopian tubes.

Transabdominal Pelvic Ultrasound

Ultrasound technique using abdominal approach.

Transverse View

Imaging bladder, uterus, and ovaries in cross-section.

Low Transverse View

Visualizes distended bladder, vagina, cervix.

Mid Transverse View

Shows bladder, uterus body, endometrium, and ovaries.

High Transverse View

Focuses on fundus of uterus and lateral ovaries.

Transvaginal Sonography

Ultrasound technique using vaginal probe.

Patient Instructions

Guidelines provided to patients before procedure.

Probe Preparation

Steps to ready ultrasound probe for use.

Examination Technique

Methodology for conducting the ultrasound examination.

Scan Orientation

Positioning of ultrasound images for accurate assessment.

Scanning Planes

Different planes used for imaging pelvic structures.

Sagittal Plane

Vertical plane dividing body into left and right.

Coronal Plane

Vertical plane dividing body into anterior and posterior.

Scan Protocol

Standardized procedure for conducting ultrasound exams.

Sagittal Protocol for Uterus

Images cervix to fundus; measures long axis.

Coronal Protocol for Uterus

Images uterine fundus, body, and cervix.

Sagittal Protocol for Ovaries

Images ovaries; measures long axis and follicles.

Coronal Protocol for Ovaries

Images ovaries; measures width and depth.

Free Fluid Assessment

Checking for fluid around uterine cavity.

Color Imaging

Technique to differentiate vascular structures from ovaries.

Disinfectant Technique

Method to sanitize equipment before procedures.

Bony Pelvis

Sacrum appears as a bright line sonographically.

Rectus Abdominis Muscles

Paired muscles inserting on pubic rami.

Hypoechoic Structures

Muscles appear darker on ultrasound images.

Rectus Sheath

Bright linear echogenic reflector separating muscles.

Obturator Internus Muscles

Located at posterior lateral corners of bladder.

Obturator Fascia

Surrounds obturator internus muscle in pelvis.

Levator Ani Muscle

Hammock-shaped muscle visualized in transverse plane.

Coccygeus Muscle

Located deep and cranially in pelvic cavity.

Piriformis Muscle

Posterior muscle not routinely visualized sonographically.

Iliopsoas Muscle

Combination of iliacus and psoas major muscles.

S/D Ratio

Peak systolic to end diastolic ratio in vascularity.

Pourcelot Resistive Index (RI)

Calculated as (A − B)/A for vascular assessment.

Pulsatility Index (PI)

Calculated as (A − B)/mean for blood flow.

Uterine Muscle Layers

Three layers: serosa, myometrium, and endometrium.

Myometrium

Middle layer with homogeneous echotexture and smooth borders.

Endometrium

Inner layer, thin and relatively hypovascular.

Subendometrial Halo

Hypoechoic area surrounding echogenic endometrial stripe.

Arcuate Vessels

Normal vessels in periphery, not pathological.

Radial Arteries

Branches supplying deeper layers of uterus.

Straight and Spiral Arteries

Arise from radial arteries before endometrium.

Uterus

Female reproductive organ for fetal development.

Cervix

Narrow lower part of the uterus.

Isthmus

Narrow section between uterus body and cervix.

Cervical inclusion cysts

Also known as nabothian cysts.

Nabothian cysts

Anechoic cysts near endocervical canal.

Echogenicity

Tissue's ability to reflect ultrasound waves.

Anechoic

Absence of internal echoes on ultrasound.

Acoustic enhancement

Increased echogenicity posterior to fluid-filled structures.

Anteverted uterus

Uterus tilted forward towards the bladder.

Retroflexed uterus

Uterus tilted backward towards the spine.

Flexion

Uterine body axis relative to cervix.

Version

Cervix axis relative to vagina.

Endometrium

Inner lining of the uterus.

Functional layer

Superficial layer of the endometrium.

Basal layer

Deep layer of the endometrium.

Menstrual phase

Days 1 to 4 of the menstrual cycle.

Hypoechoic

Lower echogenicity compared to surrounding tissues.

Proliferative phase

Days 5 to 14 of the menstrual cycle.

Secretory phase

Days 15 to 28 of the menstrual cycle.

Three-line sign

Ultrasound appearance of endometrial layers.

Endometrial thickness

Varies from 6 mm to 10 mm pre-ovulation.

Posterior enhancement

Increased echogenicity due to vascularity.

Secretory Phase

Phase of menstrual cycle with endometrial changes.

Endometrial Complex Measurement

Normal thickness is 7 to 14 mm.

Endometrial Thickness Measurement

Measured from basalis to myometrium interface.

Fallopian Tubes Identification

Difficult unless surrounded or filled with fluid.

Ovaries Mobility

Ovaries move based on bladder volume and pregnancy.

Ovarian Shape

Elliptical, with long axis oriented vertically.

Transvaginal Scanning

Superior for assessing ovarian texture.

Ovary Location

Lateral to uterus, medial to internal iliac vessels.

Ovary Localization

Easiest in coronal plane lateral to cornua.

Ovary Position Variability

Can be above uterus or in rectouterine area.

Normal Ovary Appearance

Ovoid, medium-level echogenic structure.

Follicular Cysts

May appear peripherally in ovarian cortex.

Ovary Measurement

Measured in sagittal and transverse planes.

Ovary Volume Calculation

Volume = 0.523 × length × thickness × width.

Rectouterine Recess

Most posterior peritoneal cavity reflection.