DIAGNOSING PELVICADHESIONS WITH
DYNAMIC ULTRASONOGRAPHY
Pelvicpainisafrequentcomplaintamongmanywomenandthereasonsforitaremany. Causes can be from uterine fibroids, endometriosis, pelvic inflammatory disease, ectopic pregnancy, miscarriage, a ruptured fallopian tube, and many more. Dr Steven R. Goldstein is an obgyn in Manhattan and a specialist in the use of Transvaginal Ultrasound and Sonohysterograms for diagnosing gynecological conditions such as pelvic pain. In addition to the above causes, one of the reasons may be Pelvic Adhesions.
Pelvic Adhesions are scar tissue that may cause internal organs such as the fallopian tubes, ovaries, and uterus to stick together and prevent these organs from functioning normally. Women with pelvic adhesions may experience significant pelvic pain, or painful intercourse or ovulation. Sometimes infertility is also a problem.
Dr Goldstein notes that the introduction of transvaginal probes, which employ higher frequency and provide closer proximity to structures, yielded a degree of image magnification that was dubbed sonomicroscopy. In other words, we are seeing things with our naked eye that we could not see if we could hold them in our hand at arm’s length and squint at them.An example of this is the cardiac activity clearly visible in a 3-mm embryo at 45 days from the last menstrual period. One would not appreciate this without the low power magnification of the vaginal probe.
Dr Goldstein notes that these pelvic adhesions may not be visible on the regular
ultrasounds or sonograms used by so many gynecologists. Most imagers will take a myriad of pictures, mostly still snapshots, to illustrate the anatomy of the patient. But how can you evaluate a patient’s pain only with an anatomic image? You cannot
This is where dynamic ultrasonography, which Dr Goldstein, a Gynecologist in Manhattan, has written about extensively, comes into play. Patients with pelvic adhesions and other gynecologic conditions require dynamic assessment with ultrasonography in order to be able to properly diagnose their pelvic pain.
Dr Ilan Timor-Tritsch in his book Transvaginal Sonography, states that “diagnosis of pelvic adhesions becomes possible by the sliding organ sign”. The transducer tip is pointed at the uterus, ovaries, pelvis or any pelvic finding and a gentle push pull movement of several centimeters is started.
Ifnoadhesionsarepresent,theorganswillmovefreelyinthepelvis.Thisdisplacement of organs is perceived on the screen as a sliding movement. If structures are adherent, they will move tandem with each other, allowing the operator to properly diagnose whether pelvic adhesions are present.
While this may all seem very “technical” to you, the bottom line is that pelvic pain cannot be properly diagnosed with only still images from sonograms or ultrasounds. Dynamic ultrasonography is required. Dr Goldstein, a Manhattan Obgyn, performs this procedure himself so that he can personally see the organs and feel the movement, when the patient experiences pelvic pain. He coined the phrase “the ultrasound-enhanced bimanual exam,” and believes it should become a routine part of gynecologic care.
Dr Goldstein points out that clinicians perform the bimanual exam thousands of times. The bimanual examination consists of 2 components, an objective portion and a subjective portion. The objective component attempts to discern information that is totally objective, such as, Is the ovary enlarged? If so, is it cystic or solid? Is this uterus normal in shape and contour? If so, does it feel like leiomyomas or is it globularly enlarged as with adenomyosis?
The subjective component of the bimanual examination attempts to determine whether or not tenderness is present or if there is normal mobility of the pelvic organs. The subjective component, however, depends on the experience and often the nuance of the examiner. The concept of dynamic imaging involves the liberal use of the abdominal hand as well as an in-and-out motion of the vaginal probe to ascertain aspects of the examination that in the past I deemed “subjective.” Mainly, this involves the aspects of mobility and/or tenderness.
If you are experiencing pelvic pain and have been told you need “exploratory surgery” to find the cause, first opt for “dynamic ultrasonography” offered by Dr Goldstein, a Manhattan Gynecologist and former Director of Gynecologic Ultrasound at NYU
Langone Medical center Schedule a consultation by contacting Dr Steven R Goldstein’s office.