A transvaginal pelvic ultrasound is used to study the uterus, ovaries, cervix and fallopian tubes. A small ultrasound device is inserted into the vagina and high pitched sound waves are emitted and reflected back to the transducer. These waves are analyzed and the image is displayed on a video monitor. The picture produced by ultrasound is called a sonogram, echogram or scan. A transvaginal ultrasound helps to evaluate dysfunctional bleeding and whether any uterine fibroid or polyp is present. In post menopausal women, it is used to check the thickness of the uterine lining for any cancerous growth.
Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.
Causes of Asherman's syndrome
D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.
Diagnosis and treatment of Asherman's syndrome
Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.
Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.
Pelvic ultrasound is used to detect and pain in the lower belly (pelvis) organs and examine the ovaries, uterus, cervix and the fallopian tubes. In men, it is used for bladder, prostate gland and seminal vesicles study. A pelvic ultrasound reads clearly both the organs and structures that are solid and uniform like the uterus, prostate gland or fluid-filled like bladder. It is usually used to find the cause of pelvic pain, such as ectopic pregnancy in women and tumors or masses. Trans vaginal ultrasound helps in studying the uterus and other organs better.
Scrotal ultrasound is primarily used to evaluate the disorders of the testicles and surrounding areas. Pain and swelling in the scrotum and mass in the scrotum area or any other trauma can be detected and evaluated by a scrotal ultrasound. The scrotal ultrasound is a valuable tool in determining the cause of testicular pain and swelling. Ultrasound imaging helps to identity inflammation of the scrotum and an absent or undescended testicle, testicle torsion, abnormal blood vessel or a lump or tumor. Normally it is used to detect if the prostate is enlarged.
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Bibliography / Reference
Collection of Pages - Last revised Date: September 18, 2021