Generality
Pelvic ultrasound is an exam used in diagnostic imaging, which allows the study of organs and other structures present in the lower abdominal area :
- Bladder and end portions of the intestine (rectum and sigma);
- Prostate, vas deferens and seminal vesicles in humans;
- Uterus, vagina, fallopian tubes, cervix and ovaries in women.
For the development of pelvic ultrasound, a probe is used which is placed on the skin surface, in correspondence with the anatomical area to be analyzed. With the aid of a transparent gel, this device is slipped by the operator. The reflected signal is picked up by the probe, which simultaneously sends the acquired information to a computer. These are displayed in the form of images, on a monitor located in the immediate vicinity of the location where the doctor works.
In the field of oncology, pelvic ultrasound is a widely used exam, as the tumor tissue usually has a different density than the healthy one. In this context, this survey can provide much information about the size, position and structure of the pelvic masses. However, pelvic ultrasound does not generally allow a definitive diagnosis of cancer to be made, for which specific and targeted clinical tests are required.
What's this
Pelvic ultrasound is a simple and harmless investigation, based on the emission and reception of ultrasound. This allows you to assess the size and shape of many internal organs, such as ovaries and prostate, and the abnormal areas within them, such as cysts and some tumors.
Pelvic ultrasound does not involve the use of ionizing radiation (or the injection of radioactive substances).
Ultrasound: how do they work?
Ultrasounds are sound waves emitted by a probe. This device is slid onto the skin, which is first covered with a thin layer of gel to ensure good signal transmission and allow smooth movement of the transducer.
Waves are reflected in different sizes by different tissues: for this reason, ultrasound can distinguish between cysts with liquid contents or solid masses. Unlike radiation, then, it is believed that ultrasounds cannot cause any damage to the organism.
Pelvic ultrasound is indicated to all persons for whom it is necessary to obtain information (such as size, shape, position, appearance or thickness) relating to the affected abdominal organs.
When and why is it performed?
The purpose of pelvic ultrasound is to study the morphology of the lower abdominal organs (bladder, uterus, ovaries and prostate), in order to highlight any solid atypical masses (fibroids or tumors) or cystic formations, effusions, foreign bodies or structural malformations.
Pelvic ultrasound can also be used to guide physicians during tissue sampling for histology (biopsy) or fluid drainage from a cyst or abscess.
What can you find out?
The main function of pelvic ultrasound consists in identifying the anomalous masses in the lower abdominal area . This finding contributes to a timely diagnosis, which can be followed by an effective therapy to counteract the possible pathology highlighted during the examination.
Pelvic ultrasound is able to visualize tumors, cysts and other abnormalities, adequately evaluating each clinical case. This exam also provides important information about the benign or malignant nature of the formations highlighted by the ultrasound images.
Note
Pelvic ultrasound is particularly useful for distinguishing cysts (usually benign) from solid (often malignant) masses.
Pelvic ultrasound also allows us to highlight non-tumor pathologies affecting the sexual and urinary tract and other structures located in the lower part of the abdomen.
In gynecology, suprapubic (external) pelvic ultrasound can be performed as a replacement or to complete the transvaginal ultrasound examination, in particular when the internal study is not strictly indicated (eg adolescents or virgin women).
Possible applications
Pelvic ultrasound is performed with various diagnostic reasons. The examination allows to investigate the pathologies that can involve the genito-urinary apparatus and the lower abdomen tissues (such as infectious states, hyperplasia, neoplasms and malformations).
The examination is commonly used to evaluate and monitor the treatment of the following conditions:
- Urinary tract : obstructions such as stones or other structural abnormalities of the bladder, ureters and urethra; haematuria and urination disorders etc.
- Reproductive organs : abnormalities in the anatomical structure and tumors of ovaries, uterus or fallopian tubes; pelvic inflammatory disease (PID) and other types of inflammation or infection; benign prostatic hypertrophy etc.
In selected cases, the colon, intestinal loops and appendix can also be studied.
In male patients, pelvic ultrasound is generally performed by the radiologist or urologist to study:
- Prostatic volume;
- Ability to empty the bladder (post-urination urinary residue).
In humans, this assessment is particularly useful for assessing possible prostatic lesions and intravesical formations.
In female patients, pelvic ultrasound is performed by the gynecologist or radiologist, generally to study uterus, ovaries and any pelvic masses. In the woman, in particular, the exam allows to deepen the causes of the following manifestations or conditions:
- Infertility problems or abnormal vaginal bleeding;
- Pelvic pain of unclear origin;
- Amenorrhea;
- Tumors and malformations of ovaries and uterus;
- Presence of liquids or masses in the endometrium or in the myometrium (uterine muscle tissue);
- Dilatations of the fallopian tubes;
- Presence and position of an intrauterine contraceptive device (IUD);
- Placental abnormalities (eg placenta previa) and ectopic pregnancy.
Pelvic ultrasound can also be used as a guide during in vitro fertilization, for aspiration of oocytes and fluid from the ovarian follicle.
Pelvic ultrasound during pregnancy
Pelvic ultrasound can be performed during the first month of pregnancy to show the first images of the embryo. This type of assessment can be repeated even in the most advanced stages of gestation, to monitor fetal development and obtain more detailed information of all the structures located near the cervix, without causing problems for the child.
How to do it
Pelvic ultrasound is carried out by spatial focusing, according to the various anatomical planes of the organ under examination. Before the investigation, the patient is made to lie down on his stomach and is asked to undress or to remove the clothes from the lower area of the abdomen.
The suprapubic procedure (external) requires the doctor to slide the ultrasound probe directly onto the skin, after applying a thick and transparent gel.
The ultrasounds emitted transmit a reflected signal that the device captures and sends simultaneously to a computer. In turn, this sends the information received - in the form of images - to a monitor located in the immediate vicinity of the location where the doctor works.
This allows you to view all the information needed to make the diagnosis or advise the patient on more in-depth assessments.
Internal pelvic ultrasound
Internal pelvic ultrasound involves the introduction of a probe inside the rectal canal or vagina. This method allows a better evaluation of some parts of the body, such as, for example, the prostate and female genital organs.
Endocavity probes are effective and precise, as they allow the ultrasound device to be approached sensibly to all the organs that are intended to be monitored.
Preparation
Before undergoing pelvic ultrasound, the bladder must be full. This care allows the doctor to more accurately assess the patient's clinical picture.
For this reason, it is important not to urinate and drink about half a liter of non-carbonated water at least one to two hours before the exam.
Contraindications and risks
Pelvic ultrasound is painless and carries no risk of complications. Most subjects can resume normal activities immediately after the exam.
Factors that can influence the outcome of the exam
The presence of some conditions may interfere with the test results. Pelvic ultrasound can be performed during menstruation; the doctor can advise the postponement of the examination in the case in which this phase of the menstrual cycle causes morphological modifications of the uterus and ovaries such as to invalidate the outcome of the investigation.
Other factors that can interfere with obtaining good quality ultrasound images may include:
- Severe obesity;
- Barium retention in the large intestine due to a recent diagnostic investigation which involved its use (eg barium enema);
- Presence of intestinal gases;
- Inadequate bladder filling.
At times, the operator may find it difficult to examine people who have undergone abdominal surgery in the past.
Results
After performing the pelvic ultrasound, the radiologist will analyze the images and send a signed report to the doctor who requested the examination. The latter can discuss the results with the patient and, depending on the condition encountered, may indicate further investigations to investigate the clinical picture.
Pelvic ultrasound can be prescribed as a follow-up, to monitor over time any change in a known anomaly and check whether a given treatment is effective.
Benefits of pelvic ultrasound
Ultrasound examination of the pelvis:
- It helps to identify many disorders of the urinary and reproductive system in both sexes;
- Provides a clear image of soft tissue, which does not look as good on X-ray images;
- It does not use ionizing radiation and represents the preferential imaging modality for the diagnosis and monitoring of pregnant women;
- It provides real-time images, making it an excellent tool for guiding minimally invasive procedures, such as biopsies or drainage of fluid from cysts or abscesses.
Disadvantages of pelvic ultrasound
- Pelvic ultrasound cannot be used to study structures covered by bone or gas.
- The reliability of this examination depends very much on the competence of the doctor who performs it: it is said, in fact, that the ultrasound is an "operator-dependent" investigation. For this reason, it is important that it be performed at a specialized center, by radiologists with specific experience.
- Obtaining clear ultrasound images of the structures to be examined can be technically difficult in overweight patients.
