GYN ultrasound

The plane, and which way is up

Transvaginal in coronal or three-dimensional reconstruction: the outer fundal contour and the shape of the cavity are read together, best in the secretory phase when the endometrium is bright.

Look for, in order

1. The outer fundus: a normal convex or flat contour, or a deep notch?
2. The cavity: one, two, or a septum dividing it; how far the division reaches toward the cervix.
3. Two cervices or two vaginas; the kidneys, which share an origin and are often abnormal too.

What normal looks like

A single fundus with a convex contour and a triangular cavity. A septate uterus has a normal outer contour with a divided cavity; a bicornuate uterus has a fundal notch over 1 cm; didelphys is two separate horns and usually two cervices.

Trap. Septate and bicornuate look alike on a two-dimensional scan and are managed differently; the outer fundal contour, not the cavity, separates them.

Describe it in this order

1. The plane and the approach
2. Uterus: size, position, outline, myometrium
3. Endometrium: thickness, echogenicity, outline, cavity contents
4. Cervix
5. Right adnexa, then left: ovary seen, any mass described not named
6. Pouch of Douglas: free fluid
7. Then, and only then, the impression