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Invasive Procedures in the Female Pelvis: Value of Transabdominal, Endovaginal, and Endorectal US Guidance¹

¹ From Salem Radiology Consultants, 2925 Ryan Dr SE, Salem, OR 97301 (K.A.S.); and the Department of Radiology, University of Wisconsin Hospital and Clinics, Madison (P.A.P., F.T.L.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1999 RSNA scientific assembly. Received April 5, 2000; revision requested May 19 and received December 5; accepted December 11. Address correspondence to K.A.S. (e-mail: kscanlan@wvi.com).

Transabdominal, endovaginal, and endorectal ultrasonographic (US) guidance is indispensable for a multitude of invasive procedures in the female pelvis. Transabdominal uterine US performed with a fluid-filled bladder is appropriate and convenient for guidance of difficult dilation and curettage procedures. Transabdominal intraoperative US can be employed to guide several procedures for which the more expensive intraoperative hysteroscopic procedure is now used. Aspiration of symptomatic ovarian cysts that appear benign at US with an endovaginally guided small-gauge needle is simple and effective. Simple noninfected pelvic fluid collections may be aspirated transvaginally for both diagnosis and therapy by using endovaginal guidance. Endovaginal US demonstrates the anatomic relationships of a pelvic abscess to adjacent structures, allowing safe access for transvaginal drainage. By using an endovaginal transducer with a needle guide, cervical and vaginal cuff masses may be easily sampled. An obstructed uterus may be accessed by puncturing obstructive tissue with a trocar-containing needle guided by an endorectal probe. US guidance for placement of a central brachytherapy tandem is performed via the abdominal approach after the bladder has been distended with sterile water. Endorectal US transducers may be effectively used to guide placement of interstitial brachytherapy needles in pelvic soft-tissue masses.

Index Terms: Genitourinary system, interventional procedures, 85.126 • Genitourinary system, therapeutic radiology, 85.452 • Pelvic organs, interventional procedures, 85.126 • Pelvic organs, therapeutic radiology, 85.452 • Ultrasound (US), guidance, 85.1298

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