Gynecologic Ultrasound, An Issue of Ultrasound Clinics , livre ebook

Ultrasound Clinics
Gynecologic Ultrasound

Sandra J. Allison, MD
Department of Radiology,Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007, USA

Darcy J. Wolfman, MD
Department of Radiology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA
ISSN  1556-858X Volume 5 • Number 2 • April 2010
Table of Contents
Cover image
Title page
Contributors
Ultrasound Clinics
CME Accreditation Page and Author Disclosure
Accreditation
Faculty Disclosure/Conflict of Interest
To Enroll
Preface
Technical Approach
Avoiding Pitfalls in Transvaginal Sonography of the Female Pelvis
Know the ob-gyn history
Prescan transabdominally
Check beam orientation
Understand image projection
Document the urinary bladder
Document the cervix
Determine uterine position
Check technique
Blind spots in the pelvis
Maneuver the probe
Doppler evaluation
Think beyond gynecologic conditions for pelvic pain
Pearls and Pitfalls in Sonohysterography
Preprocedural considerations
Technical issues
Diagnostic problems and limitations
Clinical Approach
Ultrasound Evaluation of Gynecologic Causes of Pelvic Pain
Acute pelvic pain in nonpregnant patients
Acute pelvic pain associated with pregnancy
Pelvic pain in the postpartum period
Chronic pelvic pain
Ultrasound for Pelvic Pain II: Nongynecologic Causes
Appendicitis
Diverticulitis
Ureteral calculus
Mesenteric adenitis
Epiploic appendagitis
Colitis
Bowel obstruction
Metastatic disease
Inguinal hernias
Hydrocele
Varicocele
Duplication cysts
Summary
Dysfunctional Uterine Bleeding: Diagnostic Approach and Therapeutic Options
Transvaginal sonography
Focal processes
Sonohysterography
Diffuse endometrial thickening
Effects of tamoxifen on the endometrium
Difficulties in endometrial stripe measurement
Summary
The Ultrasound Workup of Adnexal Masses
Anatomy and physiology
Clinical and morphologic analysis of adnexal masses
Simple cystic masses
Complex masses
Solid masses
Summary
Sonographic Evaluation of Patients Treated with Uterine Artery Embolization
Pre-embolization evaluation
Applications of Ultrasound in Gynecologic Oncology
Diagnosis and staging of gynecologic malignancy
Detection of recurrent or metastatic disease
Future
Three-Dimensional Gynecologic Ultrasound
Limitations of 3D ultrasound
Pelvic Floor Imaging
Pelvic floor anatomy and function
Conventional imaging of the pelvic floor
Ultrasound imaging
Ultrasound in the evaluation and treatment of urinary incontinence
Summary
Index
Contributors

GUEST EDITORS
SANDRA J. ALLISON, MD
Associate Professor of Radiology, Director,
Division of Ultrasound, Georgetown University
Hospital, Washington, DC
DARCY J. WOLFMAN, MD
Assistant Professor of Radiology, Georgetown
University Hospital, Washington, DC

AUTHORS
SUSAN J. ACKERMAN, MD
Professor, Department of Radiology, Medical
University of South Carolina, Charleston, South
Carolina
SANDRA J. ALLISON, MD
Associate Professor of Radiology, Director,
Division of Ultrasound, Georgetown University
Hospital, Washington, DC
TERESITA L. ANGTUACO, MD
Professor of Radiology and Obstetrics, and
Gynecology, Department of Radiology,
University of Arkansas for Medical Sciences,
Little Rock, Arkansas
MUNAZZA ANIS, MD
Assistant Professor, Department of Radiology,
Medical University of South Carolina,
Charleston, South Carolina
OKSANA H. BALTAROWICH, MD
Associate Professor of Radiology, Division
of Diagnostic Ultrasound, Department of
Radiology, Thomas Jefferson University,
Philadelphia, Pennsylvania
ASHLEY CORBETT BRAGG, MD
Radiology Resident, Department of Radiology,
University of Arkansas for Medical Sciences,
Little Rock, Arkansas
NATASHA BRASIC, MD
Clinical Instructor, Ultrasound and Breast
Imaging, Department of Radiology and
Biomedical Imaging, University of California
San Francisco, San Francisco, California
MARION BRODY, MD
Fellow, Abdominal Imaging, Department
of Radiology, Hospital of the University
of Pennsylvania, Philadelphia, Pennsylvania
LAWRENCE A. CICCHIELLO, MD
Department of Diagnostic Radiology, Yale
University School of Medicine, New Haven,
Connecticut
BEVERLY COLEMAN, MD, FACR
Professor and Associate Chairman
of Radiology, Department of Radiology,
Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania
VICKIE A. FELDSTEIN, MD
Professor of Clinical Radiology and Obstetrics,
Gynecology and Reproductive Sciences,
Department of Radiology and Biomedical
Imaging, University of California San Francisco,
San Francisco, California
ULRIKE M. HAMPER, MD, MBA
Professor of Radiology and Urology
Director, Division of Ultrasound,
Department of Diagnostic Radiology,
The Johns Hopkins Medical Institutes,
Baltimore, Maryland
MINDY M. HORROW, MD, FACR
Director of Body Imaging, Department of
Radiology, Albert Einstein Medical Center;
Associate Professor of Radiology, School of
Medicine, Thomas Jefferson University,
Philadelphia, Pennsylvania
ABID IRSHAD, MD
Associate Professor, Department of Radiology,
Medical University of South Carolina,
Charleston, South Carolina
ANNA S. LEV-TOAFF, MD, FACR
Professor of Radiology, Department of
Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania
DOLORES H. PRETORIUS, MD
Professor of Radiology, Department of
Radiology, University of California San Diego,
San Diego, California
LESLIE M. SCOUTT, MD
Professor of Radiology and Chief, Ultrasound
Service, Department of Diagnostic Radiology,
Yale University School of Medicine, New
Haven, Connecticut
CECILE A. UNGER, MD
Resident, Department of Vincent
Obstetrics and Gynecology,
Massachusetts General Hospital,
Boston, Massachusetts
MILENA M. WEINSTEIN, MD
Assistant, Division of Urogynecology
and Reconstructive Pelvic Medicine,
Department of Vincent Obstetrics
and Gynecology, Massachusetts
General Hospital, Boston,
Massachusetts
DARCY J. WOLFMAN, MD
Assistant Professor of Radiology,
Georgetown University Hospital,
Washington, DC
Ultrasound Clinics
Forthcoming Issues
July 2010
Genitourinary Ultrasound
Mukund Joshi, MD, and Paul Sidhu, MD,
Guest Editors

October 2010
Vascular Ultrasound
Beatrice L. Madrazo, MD, Guest Editor

January 2011
Advanced Obstetric Ultrasound
Theodore Dubinsky, MD, and
Manjiri Dighe, MD, Guest Editors

RECENT ISSUES
January 2010
Pediatric Ultrasound, Part 2
Brian D. Coley, MD, Guest Editor

October 2009
Pediatric Ultrasound Part 1
Brian D. Coley, MD, Guest Editor

July 2009
Advances in Ultrasound
Vikram Dogra, MD, Guest Editor
CME Accreditation Page and Author Disclosure


Goal Statement
The goal of the Ultrasound Clinics is to keep practicing radiologists and radiology residents up to date with current clinical practice in ultrasound by providing timely articles reviewing the state of the art in patient care.

Accreditation
The Ultrasound Clinics is planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Virginia School of Medicine and Elsevier. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
The University of Virginia School of Medicine designates this educational activity for a maximum of 15 AMA PRA Category 1 Credits™ for each issue, 60 credits per year. Physicians should only claim credit commensurate with the extent of their participation in the activity.
The American Medical Association has determined that physicians not licensed in the US who participate in this CME activity are eligible for a maximum of 15 AMA PRA Category 1 Credits™ for each issue, 60 credits per year.
Credit can be earned by reading the text material, taking the CME examination online at http://www.theclinics.com/home/cme , and completing the evaluation. After taking the test, you will be required to review any and all incorrect answers. Following completion of the test and evaluation, your credit will be awarded and you may print your certificate.

Faculty Disclosure/Conflict of Interest
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
All authors/editors participating in an accredited CME activity are expected to disclose to the readers relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the reader. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliation