MRI was superior to TVUS and transrectal US in diagnosing retrocervical endometriosis [45]. Transrectal US is limited to a small anatomic area [43] but can be useful in some patients, especially those unable to undergo TVUS [45]. US Pelvis Transvaginal TVUS, especially when combined with real-time physical examination, can be useful in the detection of both ovarian and nonovarian endometriosis. Some studies have demonstrated superiority of TVUS over MRI in the detection of rectosigmoid and retrocervical endometriosis [46-49]. TVUS can demonstrate macroscopic endometriomas that are often bilateral. On US, an endometrioma typically appears as an adnexal or ovarian mass with homogenous low-level internal echoes. The presence of echogenic foci in the wall (hemosiderin deposits) or multilocularity further increases the likelihood that a mass with this appearance is an endometrioma [50]. Nonovarian endometriosis can be assessed best with dynamic US by looking for the uterine sliding sign, assessing for nodules at sites of tenderness, assessing ovarian mobility, and looking for hypoechoic nodules outside of the ovaries [51]. US Sonohysterography To our knowledge, there is no relevant literature to support performing isolated US sonohysterography in patients with a history or clinical suspicion of endometriosis. Contrast sonohysterography or saline-infusion sonohysterography (SIS) provides an assessment of the uterine cavity. Although the endometrium can be assessed by TVUS, SIS is particularly useful in assessing potential causes of infertility, including intrauterine adhesions, endometrial polyps, and leiomyomas [52]. Antibiotic administration or prophylactic use of antibiotics is at the discretion of the referring physician if there is a prior history of PID or if hydrosalpinx is noted at the time of the study.
Female Infertility. MRI was superior to TVUS and transrectal US in diagnosing retrocervical endometriosis [45]. Transrectal US is limited to a small anatomic area [43] but can be useful in some patients, especially those unable to undergo TVUS [45]. US Pelvis Transvaginal TVUS, especially when combined with real-time physical examination, can be useful in the detection of both ovarian and nonovarian endometriosis. Some studies have demonstrated superiority of TVUS over MRI in the detection of rectosigmoid and retrocervical endometriosis [46-49]. TVUS can demonstrate macroscopic endometriomas that are often bilateral. On US, an endometrioma typically appears as an adnexal or ovarian mass with homogenous low-level internal echoes. The presence of echogenic foci in the wall (hemosiderin deposits) or multilocularity further increases the likelihood that a mass with this appearance is an endometrioma [50]. Nonovarian endometriosis can be assessed best with dynamic US by looking for the uterine sliding sign, assessing for nodules at sites of tenderness, assessing ovarian mobility, and looking for hypoechoic nodules outside of the ovaries [51]. US Sonohysterography To our knowledge, there is no relevant literature to support performing isolated US sonohysterography in patients with a history or clinical suspicion of endometriosis. Contrast sonohysterography or saline-infusion sonohysterography (SIS) provides an assessment of the uterine cavity. Although the endometrium can be assessed by TVUS, SIS is particularly useful in assessing potential causes of infertility, including intrauterine adhesions, endometrial polyps, and leiomyomas [52]. Antibiotic administration or prophylactic use of antibiotics is at the discretion of the referring physician if there is a prior history of PID or if hydrosalpinx is noted at the time of the study.