Assessment of the cervix and vagina in the routine transvaginal scan
By Angela Clough, Derriford Hospital, University Hospitals of Plymouth NHS Trust
Background
Views of the cervix in a routine transvaginal scan are usually obtained when assessing the uterus appearance and size, and the vagina may be partially visualized in the introitus view. Focused interrogation of these structures however is invaluable in helping to detect a range of pathologies which may be the cause of common presenting symptoms such as dysfunctional bleeding. This poster discusses how and why to improve imaging of the cervix and vagina and presents images of detectable pathologies.
Discussion
Focused assessment of the cervix should be performed in two planes with optimization of the image depth, field of view and focal zone. A longitudinal view should demonstrate the full length of the endocervical canal, with views of the bladder to help estimate the locations of the internal os and torus. Identifying a normal endocervical canal will generally exclude common pathologies such as cervical polyps, submucosal fibroids and the most common form of cervical cancer, which develops within the canal (exophytic). Although ultrasound is not the first-line test for cervical cancer, it can be an unexpected finding, presenting as an endocervical mass. In addition, there are other rare-type cervical cancers, such as small cell cancer, that can be missed in cervical screening and may be detected on ultrasound as isoechoic lesions within the cervical wall (endophytic).
A remaining vaginal stump following hysterectomy for uterine or cervical pathology also requires detailed assessment for possible recurrence. Specific assessment of the introitus view for nodules within the rectovaginal septum is important in suspected deep infiltrating endometriosis. Focal assessment of the cervix and vagina may also help detect cervical and vaginal cysts, adhesions and/or endometriotic nodules within the POD, and incidental bladder/urethral pathology.
Conclusion
Focused assessment of the cervix and vagina is advantageous in the routine scan, with the potential to detect a range of pathologies.