Trans-vaginal scan

Dr. Ahmad Z. El-Sheikhah

FRCOG, M.D, Diploma of Fetal Medicine
Prof. Obstetrics and Gynaecology
 Aims of scan

Examine the uterus and ovaries

Understand the normal physiological
changes in those organs
Check the fallopian tubes for
abnormalities
Check cervical length & diameters
 Scanning the uterus

The uterus is the first point of referral in the course of an ultrasound examination, due to its
dimensions and central position. The principal scansion planes for its study are longitudinal and
transverse
 Myometrium

Transvaginal scan of the uterus, longitudinal section, showing the three myometrial
layers: the external layer (1), clearly distinguishable from the middle one (2) because
of the ectasy of the arcuate vein. The internal myometrial layer, or subendometrial, is
less echogenic than the others (“hypoechoic halo”).
 Endometrium

Appearance of the endometrial mucosa during the course of a physiological

cycle
 Endometrium

During the late proliferative phase the endometrium assumes a “trilaminar” appearance
in the secretive phase the endometrium appears thickened and hyperechogenic.
 Uterine cycle

Follicular phase Luteal phase

Endometrium
 Endometrium in the menopause

The endometrial mucosa of the anterior and posterior walls

appears thin <5mm and linear sometimes a small quantity of
anechoic fluid(*) is visible inside the endometrial cavity
 Cervix

by maneuvering the probe posteriorly it is possible to visualize the cervix in

greater detail, and to distinguish the anterior and posterior lips. In the
periovulatory phase it is common to find a small quantity of mucus at the level
of the endocervical canal.
 Douglas pouch

The pouch of Douglas is the first site of collection of free fluid in the abdomen,
minimal fluid is normal particularly around ovulation, echogenic fluid is suggestive of
blood or pus.
Bicornuate uterus
Bicornuate uterus
Uterine septum
Assessment of uterine cavity
Assessment of uterine cavity
Assessment of uterine cavity
Endometrial polyps
Endometrial polyps
Uterine fibroids
Uterine fibroids
Uterine fibroids
Uterine fibroids
 Evaluation of the ovaries

Dominant Follicle Corpus luteum

1-peripherally located cyst dissappears
2-clear content,
3-echogenic edge
4-size usually under 25mm
 Corpus luteum

A) Transvaginal scan of a corpus luteum, greatly magnified. B)

The same scan as A: Power Doppler reveals a strong blood flow
around the corpus luteum (“ring of fire”).
Corpus luteum
Haemorrhagic corpus lute
Corpus lutem
 Anovulation and PCO

Typical appearancoe of peripherally arranged follicles, hyperechogenic

stroma, increased ovarain volume and lack of dominanace
Monitor ovarian stimulation
 Ovarian cysts

Simple cyst Dermoid cyst

clear fluid echogenic contents
Smooth wall nodule in cyst wall
 Endometriosis & haemorrhagic cysts

Haemorrhagic cyst Endometrioma

Echogenic contents thick wall
Resolves spontaneously clinical picture
 Fallopian tubes

(left)Transvaginal scan, transverse section at the level of the left adnexa. SBL:
small bowel loops. PSV: pelvic side wall.
(Right) large hydrosalpingx
 Fallopian tubes

Edematous salpinx during the development of salpingitis. The

presence of a small quantity of free fluid in the abdomen makes
its visualization possible
Thank you
 Further Information

▪ www.fetalmedicine.com
▪ www.thefetus.com
▪ www.omnim.com
▪ http://www.ncbi.nlm.nih.gov/Omim/
searchomim.html
▪ www.prenataldiagnosis.com