Crazy case I saw recently… 38 yo female who came to the ED for vaginal bleeding that was unrelenting for 6 months, not changed with repeated PO hormonal treatment by PCP, and “I just want an answer.” Stable vitals, no sx of anemia, she was not tender on exam and pelvic was unremarkable except for some blood. In my efforts to simply appease her as I wasnt going to do much more, I did a Transabdominal Pelvic US (sagittal view shown below). Once I saw this, I started to pay more attention (of course, it should have been the other way around, but thats just my skeptical self). I asked her about weight loss (she had 15 pounds loss in 6 months (already a pretty petite girl) and no significant family history, but I realized when speaking to her for more time that she kept having an intermittent dry cough every now and again. I asked her about it, and she thought it was allergies “and I just dont think i got over that cold from a month ago.” Pretty sad case -CXR showed mets…..”platinum” scan done, admitted to Medicine, biopsy/onc/chemo underway… shows the importance of TA Pelvis for not just the 1st trimester pregnancy VB/abd pain evaluations.
SonoTutorial TA Pelvis: Using the curvilinear probe, fan through sagittal and transverse planes with a full bladder for better visualization (fluid is the lover of US!) and look at the contour of the uterus (should be the same echogenicity (shades of gray) throughout with an endometrial stripe measuring 5-7mm in days 6-14 of the menstrual cycle and up to 7-16mm in the secretory phase. If postmenopausal then it depends on oral hormonal therapy intake (no intake – less than 5 mm without focal thickening excludes significant disease and is consistent with atrophy; hormone replacement can vary by 3mm; anything over 8mm is bad new bears and needs biopsy). Of course, dont forget to look for free fluid between the bladder/uterus and uterus/rectum as well as the ovaries if able (may need transvag for those).
For information and education on pelvic ultrasound as it relates to postmenopausal women, go here.