Ultrasound

Pelvis

For women, pelvic ultrasound is most often used to examine the uterus and ovaries and, during pregnancy, to monitor the health and development of the embryo or fetus. In males, a pelvic ultrasound usually focuses on the bladder and the prostate gland.

For females, ultrasound examinations can help determine the causes of pelvic pain, abnormal bleeding, or other menstrual problems. Ultrasound images can also help to identify palpable masses such as ovarian cysts and uterine fibroids, as well as ovarian or uterine cancers. For males, pelvic ultrasound is a valuable tool for evaluating the prostate, as well as for evaluating the tubes that carry semen. In both sexes, a pelvic ultrasound exam can help to identify tumors and other disorders of the urinary bladder. Because ultrasound provides real time images, it can also be used to guide procedures, such as needle biopsies, in which a thin needle is used to sample cells from an abnormal area for laboratory testing.

There are three methods of performing pelvic ultrasound: abdominal (transabdominal), vaginal (transvaginal, endovaginal) in women, and rectal (transrectal) in men. The same principles of high-frequency sound apply in each technique.

Transabdominal: The patient has a full urinary bladder and is positioned on an examination table. A clear gel is applied to the lower abdomen to help the transducer make secure contact with the skin. The sound waves produced by the transducer cannot penetrate air, so the gel helps to eliminate air pockets between the transducer and the skin. The sonographer then presses the transducer firmly against the skin and sweeps it back and forth to image the pelvic organs. There may be varying degrees of discomfort from pressure as the sonographer guides the transducer over your abdomen, especially if you are required to have a full bladder. At times the sonographer may have to press more firmly to get closer to the area of interest to better visualize the structure. This discomfort is temporary and in general, this is a painless procedure. Also, you may dislike the feeling of the water-soluble gel applied to your abdomen.

Transvaginal: This approach involves the insertion of the transducer into the vagina after the patient empties her bladder and is performed very much like a gynecologic exam. The tip of the transducer is smaller than the standard speculum used when performing a Pap test. A clean protective cover is placed over the transducer, lubricated with a small amount of gel, and then inserted into the vagina. Only two to three inches of the transducer are inserted into the vagina. The images are obtained from different orientations to get the best views of the uterus and ovaries. Transvaginal ultrasound is usually performed with the patient lying on her back with her legs spread apart, similar to a Pap smear or internal exam.

Transrectal: The prostate gland is located directly in front of the rectum, so the ultrasound exam is performed transrectally. A protective cover is placed over the transducer, lubricated, and then placed into the rectum so the sound need only travel a short distance. The images are obtained from different orientations to get the best view of the prostate gland. Ultrasound of the prostate is most often performed with the patient lying with his left side down on the table and with his knees bent up slightly.

If a suspicious lesion is identified with ultrasound or with a rectal examination, an ultrasound-guided biopsy can be performed. This procedure involves advancing a needle into the prostate gland while the radiologist watches the needle placement with ultrasound. A small amount of tissue is taken for microscopic examination.

Depending upon which type of study, the ultrasound examination takes 15-30 minutes.