Transabdominal versus Transvaginal Imaging

Transabdominal midline images of the pelvis in the longitudinal plane will show the long axis of the uterus posterior to the distended bladder. The cervix will be visualized immediately posterior to the angle of the bladder. The posterior cul-de-sac (pouch of Douglas) is a potential space where free intraperitoneal fluid may be found, posterior to the uterus (Fig 109-4). When a normal anteverted uterus is imaged, the uterus meets the vagina at an angle of 90° or greater, dependent on the amount of bladder distention. Retroversion of the uterus is a normal variant and can make transabdominal visualization of the uterine fundus difficult. The position of the uterus is less important when the transvaginal probe is used.

FIG. 109-4. Free fluid. The markers indicate the uterine dimensions on this transabdominal scan in the longitudinal (sagittal) plane. The anechoic bladder is seen anteriorly and anechoic free fluid is seen posteriorly (pouch of Douglas) and on the left side of the image.

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