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Figures in Original Article by Vittorio Luigi Piloni (*) - Liana Spazzafumo (**)

Sonography of the female pelvic floor:clinical indications and techniques.

(*) Centro Diagnostico "N. Aliotta", Casa di Cura Villa Silvia, Senigallia (Ancona)
(**) Centro di Biometria e Statistica Sanitaria, Dipartimento Ricerche Gerontologiche INRCA (Ancona)


(Figs. 1)

Longitudinal scan

Fig 1 a. – Standardized documentation of female perineal sonogram. (a) Longitudinal scan: with the transducer displayed at the bottom of the screen, caudal of the patient is seen at the lower edge and cranial at the top; the left side of the scan is ventral and the right side is dorsal. The same orientation is displayed in this standard MRI sagittal scan of female pelvis (b)

MRI sagittal scan

Fig 1 b.


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(Figs. 2)


Transperineal sonographic technique

Fig 2 a. Transperineal sonographic technique : with the transducer positioned on the sagittal scanning plane just under the symphysis pubis (position one) the typical appearances of the bladder, urethra and urethro pubic ligaments are displayed (a);


Ultrasound scan

Fig. 2 b. – Moving probe handle anteriorly (position two), permits inclusion of the vaginal canal, utero-vesical junction and Douglas pouch (b) within ultrasound beam.


Post-anal space

Fig. 2 c. – When transducer handle is moved even further anteriorly so that a vertical position (position three) is reached the end of transducer points more caudally and the anorectum is depicted together with the post-anal space ( c ).



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(Figs. 3)

Internal and external anal sphincters

Fig. 3 a. The scanning plane depicted in Fig. 2 c is rotated 90° counterclockwise until a short axis view of the anal canal is obtained which displays the internal and external anal sphincters (a), together with the mucosa-submucosa complex and the puborectalis muscle.

Coronal plane

Fig 3 b. Then, the transducer handle is moved posteriorly to permit inclusion of the bladder, urethra and urethro-pelvic ligaments within ultrasound beam displayed on the coronal plane (b).


Axial view

Fig 3 c. Occasionally, depending on proper inclination of the urethral axis, an axial view of the four-rings target like urethra is seen ( c ).

 

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