Sonographic findings of a gynecological cause of acute pelvic pain – a systematic review

Endometrial thickening or fluid as a result of endometritis

Internal echoes or fluid levels in a complicated purulent fluid in the pelvis

Pyosalpinx causes dilated fluid-filled fallopian tubes with internal echoes and elevated fluid levels due to purulent debris

A multiloculated, septated mass with poorly defined irregular boundaries, internal echoes, and difficulties distinguishing the ovary from the fallopian tube due to tissue degradation is seen on sonography of a tubo-ovarian abscess

Air from gas-producing organisms can be detected in TOA as echogenic foci with posterior dirty shadowing.

On color Doppler, blood flow may be detected in the tissues between the tubo-ovarian abscess loculations

Enlargement of the uterus or a decidual response in the endometrium in the absence of a gestational sac

A diagnostic finding is a gestational sac in the adnexa containing a fetal pole with heart tones and a yolk sac.

Within the uterus, a cystic formation resembling a gestational sac may be observed. This decidual reaction has a single shape, but an early gestational sac has a twofold decidual reaction, though with a thin outer layer. Echogenic fluid due to blood often occurs within the pseudogestational sac.

The endometrial cavity echoes may also be exceptionally thick due to a decidual reaction without a pseudo sac.

Color Doppler may be helpful because a rim of vessels surrounds and supplies an ectopic pregnancy.

A low-resistance pattern at the center of a nonspecific extraovarian mass is typical of an ectopic pregnancy.

Heterogeneous ovarian echotexture

Whirlpool sign indicating the twisted pedicle appearing as a hypoechoic band

The cut-section of a twisted pedicle may resemble a snail shell or massive echogenic or hypoechoic masses

Lack of vascularity

No flow on duplex Doppler

Whirlpool sign indicating the vessels looping around the center axis

A follicular cyst has a thin wall, posterior acoustic enhancement, and increased echogenicity posterior to the cyst.

The corpus luteum is usually unilocular, with a diameter of less than 3 cm and a thin wall. The cysts have internal echoes at low levels.

Cyst whose walls are thick or the fluid within the cyst is more echogenic than it is in a solid cyst.

A follicular cyst on pulsed Doppler reveals no internal vascularity

The core echogenic solid-looking regions of a corpus luteum cyst have considerable peripheral blood flow (“ring of fire” on Doppler) but little internal vascularity.

Duplex Doppler reveals prominent diastolic flow with low-velocity waveform throughout the luteal phase of the cycle.

In the sagittal plane, there is an interrupted endometrial line.

Endometrium with punctate echogenic foci

Endo-myometrial junction is indistinct.

Endometrium indistinct or thin (6 mm), and failing to improve with hormone

treatment instead of normal ovaries and hormonal profile

In the endometrium, there is a small amount of loculated fluid appearing as multiple small cystic areas.

Fibrosis is considered if there is a hyperechoic lesion with no posterior shadowing, while calcification is considered if there is posterior shadowing.