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Transvaginal ultrasound examination is an excellent tool for solving clinical problems in women with symptoms suggesting the presence of adnexal mass. An experienced ultrasound examiner can confidently discriminate between benign and malignant pelvic tumours in the adnexal region using pattern recognition. Some tumours - for example, endometriomas, dermoid cysts, hydropyo- and haematosalpinx, peritoneal pseudocysts, paraovarian cysts, haemorrhagic corpus luteum cysts, myomas, abscesses and ovarian fibromas, thecomas and Brenner tumours - may present with typical appearances at greyscale imaging. Doppler assessment of intratumoral blood flow contributes little to the correct specific diagnosis of adnexal mass. The ability to make a correct specific diagnosis in a series of pelvic tumours is highly dependent upon the types of tumour in the tumour series studied. The surgical removal of the adnexal mass with benign ultrasound morphology is incidentally detected at ultrasound examination in asymptomatic women.
This book came about because the Royal College of Obstetricians and Gynaecologists took a decision to integrate gynaecological ultrasound imaging into gynaecological practice and set up a Special Skills Module in gynaecological ultrasound. The theoretical content for this module was delivered at regular meetings in September for seven consecutive years. These meetings were always over-subscribed and enormously popular. We had put together the contents of the meeting and the lectures were delivered by leaders in the field, most of whom are authors in this book.
We would like to think that our efforts led to the next change, which was integration of ultrasound into gynaecology training. This change has now taken place and, thus, the need for a separate training module has disappeared. However, the need for a reference source remains, and this was our driving force in producing this book.
It is clear to us that the use of ultrasound imaging in gynaecology goes well beyond simple picture recognition. A skilful gynaecological sonographer will bring together scan findings and the clinical scenario to enhance patient care. We believe this leads to targeted investigations and, just as importantly, to strategies for non-intervention. We have included chapters on clinical gynaecology, which we believe are essential for making best use of gynaecological ultrasound, and we make no apology for doing so in what some may see as an ultrasound textbook.
Haemorrhagic corpus luteum cysts are common causes of acute pelvic pain in women of fertile age. At ultrasound examination, corpus luteum cysts are characterised by spiderweb-like contents but they may also contain bizarre-looking blood clots. This explains why corpus luteum cysts may sometimes be confused with malignancy. Endometriomas may cause pelvic pain but they are also quite common incidental ultrasound findings. A serious condition that may be more or less painful is torsion of the adnexa. Torsion occurs in adnexa containing a lesion, such as ovarian cyst or hydrosalpinx, but it may also occur in normal adnexa, especially in prepubertal girls. Uterine fibroids and adenomyosis may sometimes cause pelvic pain. Gynaecologists should be able to recognise the ultrasound image of non-gynaecological conditions that may cause pelvic pain. Ultrasound images of these conditions may be encountered when an ultrasound examination is performed because of suspicion of gynaecological disease.
A gynaecological ultrasound examination can be performed transabdominally, transvaginally or, in exceptional cases, transrectally. Irrespective of the route of examination it is always important to optimise the image and to perform a systematic examination. There are two reasons to adopt a systematic scanning technique. First, it will ensure that a complete pelvic examination is performed. Second, if one always scans all the organs in the pelvis in a systematic way, he/she can build up a reference of what is normal, which increases confidence in detecting pelvic pathology. The uterus and ovaries are smaller in postmenopausal women than in women of fertile age. The endometrium has uniform ultrasound morphology because there are no cyclical hormonal changes. The ovaries contain no follicles but one or more inclusion cysts no larger than 10 mm are seen in healthy postmenopausal women.
Ultrasound plays an integral part in the diagnosis and management of many gynaecological conditions; indeed, ultrasound forms part of the RCOG's mandatory training programme for doctors wishing to specialise in obstetrics and gynaecology. This book will be of use to both trainees and those already in clinical practice looking for a user-friendly reference guide. The use of ultrasound in gynaecology goes well beyond simple picture recognition: a skilful gynaecological sonographer will bring together scan findings and the clinical scenario to enhance patient care. This leads to targeted investigations and strategies for intervention. This book covers all aspects of the use of ultrasound in the fields of gynaecology and early pregnancy, with the contents including: postmenopausal bleeding; adnexal masses; pelvic pain; reproductive medicine; miscarriage; ectopic pregnancy; and ovarian cysts.
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