Lago Mar acute pelvic pain - gohofoundation.org · of women with acute pelvic pain Beryl Benacerraf...
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Ultrasound for the evaluation of women with acute pelvic pain Beryl Benacerraf M.D Harvard Medical School Ultrasound is a real-time imaging technique that combines imaging with physical exam • The ability to examine and image patients simultaneously offers considerable often neglected value, unique to ultrasound as a cross sectional imaging technique. • Tenderness-guided ultrasound is an effective way of detecting implants of painful deep penetrating endometriosis. • Testing the movement of lesions while scanning is essential to make the correct dx Get a history during the exam • How long has she been in pain • Diffuse or focal • Cyclical or constant • Sharp or dull or cramping • ? Prior surgery • Menopausal and hormonal status • Could she be pregnant? During the scan • How tender is the patient? • Where is the tenderness? Focal? • Do organs slide past each other? • Push deliberately on each part of the pelvis with the probe and other hand to determine where the pain comes from. • Talk to the patient! The uterus – non pregnant • Degenerating or torsed fibroid • Malpositioned IUD • Hematometra (blockage at cervix or beyond) Many Faces of Degen. Fibroids
Transcript of Lago Mar acute pelvic pain - gohofoundation.org · of women with acute pelvic pain Beryl Benacerraf...
Ultrasound for the evaluation of women with acute pelvic pain
Beryl Benacerraf M.DHarvard Medical School
Ultrasound is a real-time imaging technique that combines imaging with physical exam
• The ability to examine and image patients simultaneously offers considerable often neglected value, unique to ultrasound as a cross sectional imaging technique.
• Tenderness-guided ultrasound is an effective way of detecting implants of painful deep penetrating endometriosis.
• Testing the movement of lesions while scanning is essential to make the correct dx
Get a history during the exam• How long has she been in pain• Diffuse or focal• Cyclical or constant• Sharp or dull or cramping• ? Prior surgery• Menopausal and hormonal status• Could she be pregnant?
During the scan• How tender is the patient?• Where is the tenderness? Focal?• Do organs slide past each other?• Push deliberately on each part of the
pelvis with the probe and other hand to determine where the pain comes from.
• Talk to the patient!
The uterus – non pregnant
• Degenerating or torsedfibroid • Malpositioned IUD• Hematometra (blockage at
cervix or beyond)
Many Faces of Degen. Fibroids
Localization of IUD reconstructed coronal view of uterus
Abn. Located IUDs may be a common cause of pain and bleeding
Using the shadow
Is the uterus too small? Does the IUD fit?
• Hemorrhagic cyst / hemorrhagic corpus luteum• Torsed ovary or tube• Hydrosalpinx• Tubo-ovarian abcess - PID• Ectopic pregnancy
The Adnexa Hemorrhagic Cyst
Peritoneal inclusion cyst
Two similar size cystic masses in ovary
Ovarian cancer
This 48 year old patient complained of pelvic pain.
Torsed Ovary
12 wks for NT asymptomatic
TorsedTube
Ovarian cyst?
Focal Pain when tube is moved:Salpingitis at laparoscopy
TOA
Could be PID or ectopic
+ BetaSubunit
Second opinion for suspected hydroalpinx
Congenital megaureter Pain with a + pregnancy test• Pregnancy of unknown
location• Tubal, cervical, cornual
pregnancy• Ongoing SAB• C-section scar pregnancy
4.5 weeks sac Is this pregnancy intrauterine?
Is this pregnancy intrauterine? Is the sac in the
uterus?
Pt came in for NT scan
Non-GYN causes of pain
• Ureteral stone• Appendicitis• Irritable bowel syndrome• Diverticulitis• Inflamatory bowel disease• Adhesions
Appen
dix
Acute RLQ pain
Appendicealabcess
Postmenopausal patient with LLQ pain X 1 week
Diverticular abcess
Conclusions
• Accurate Dx requires a combo of ultrasound, physical exam and history, not just still images.
• Most of the diagnoses can be made with ultrasound without the need for CT and MR.
• Patients with pelvic pain are miserable and deserve the extra care and attention.
