EMED Case Study: Identifying Endometrioma with Ultrasound

Posted by BK Ultrasound on Sep 22, 2016 10:00:00 AM

jerry_chirocolo.jpgJerry Chiricolo, MD FACEP
Chief, Division of Clinical Ultrasound, New York Methodist Hospital, USA

 

 

 


A 26-year-old female, with no significant past medical history, presented to the emergency department complaining of severe lower abdominal pain. It began as moderate intensity, right lower quadrant (RLQ) pain and was associated with her menses beginning six days prior; however, it acutely worsened two hours prior to arrival. The pain was now sharp and localized to the RLQ, and radiated to the lower back. On presentation, the patient appeared in moderate distress with normal vital signs. The patient was evaluated by the emergency medicine physician who elicited right adnexal tenderness on physical examination. The clinical concerns included ovarian torsion and an immediate point-of-care ultrasound was performed. 

The portable bk3500 ultrasound system was brought to the bedside. The high frequency E10C4 endocavity transducer was utilized to scan the pelvic structures in multiple planes. The ultrasound revealed a large right ovarian cyst (fig. 1). The presumptive diagnosis of an endometrioma, a.k.a. chocolate cyst, was made based on the unilocular and homogeneous ground glass internal echo pattern of cyst contents.  The compressed ovarian stroma with demonstrable Doppler flow, along with the absence of gray scale findings of ovarian torsion such as stromal edema and peripheralized follicles, immediately reassured the emergency physician that the time-sensitive surgical emergency of ovarian torsion was less likely (fig. 2).  Due to the patient’s persistent pain, a gynecologist was consulted and the decision was made to admit the patient and perform an exploratory laparoscopy. The patient subsequently underwent a cystectomy of her endometrioma, which was confirmed by pathology.

new1_CMYK-3.jpgE10C4_endometrioma_-_Dr._Chiricolo_new2_CMYK.jpg

There are many time-sensitive diagnoses where point-of-care ultrasound can have tremendous impact. Traditionally, that focus has been on the hemodynamically unstable patient presenting with life threatening physiology.  Ovarian torsion, however, is an organ-threatening condition associated with deleterious consequences.  The superior performance of the bk3500 allowed the emergency physician to confidently diagnose an endometrioma and prioritize surgical intervention in a timely manner.  In addition to its simple user interface and seamless workflow, which is perfect for all point-of-care users, the bk3500 is also ideal for experienced users due to its exceptional dynamic range, high-resolution imaging, and easily accessible advanced features.

There are many time-sensitive diagnoses where point-of-care ultrasound can have tremendous impact. Traditionally, that focus has been on the hemodynamically unstable patient presenting with life threatening physiology.  Ovarian torsion, however, is an organ-threatening condition associated with deleterious consequences.  The superior performance of the bk3500 allowed the emergency physician to confidently diagnose an endometrioma and prioritize surgical intervention in a timely manner.  In addition to its simple user interface and seamless workflow, which is perfect for all point-of-care users, the bk3500 is also ideal for experienced users due to its exceptional dynamic range, high-resolution imaging, and easily accessible advanced features.

Conclusion:

Endometriosis and an accompanying endometrioma is a painful and often debilitating process that can cause emergent complications such as ovarian torsion.  Ovarian torsion is an emergent, time-sensitive diagnosis. The exceptional image quality of the bk3500 in this case allowed the physician to quickly and accurately confirm the diagnosis.  Although ultrasound is not able to fully exclude torsion, the system provided enough diagnostic information to assure the clinician that the diagnosis was unlikely.  Experienced point-of-care users routinely incorporate clinical ultrasound in the diagnostic evaluation of non-obstetrical pelvic pain. A high-performance ultrasound system, such as the bk3500, can provide emergency physicians with the diagnostic confidence they need when performing these advanced ultrasound applications.

bk3500 Ultrasound System for Emergency Medicine

Topics: Emergency Medicine

Written by BK Ultrasound