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Seminars in Ultrasound, CT, and MR Feb 2021Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and... (Review)
Review
Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.
Topics: Chronic Pain; Diagnostic Imaging; Female; Humans; Pelvic Pain; Pelvis; Syndrome; Varicose Veins; Vascular Diseases
PubMed: 33541587
DOI: 10.1053/j.sult.2020.07.001 -
Annals of Medicine Dec 2022Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological... (Review)
Review
Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.
Topics: Embolization, Therapeutic; Female; Humans; Pelvic Pain; Pelvis; Varicose Veins
PubMed: 34935563
DOI: 10.1080/07853890.2021.2014556 -
Obstetrics and Gynecology Clinics of... Dec 2019This article reviews normal pelvic anatomic findings during ultrasound and discusses how to obtain and measure these images. Representative images of normal pelvic... (Review)
Review
This article reviews normal pelvic anatomic findings during ultrasound and discusses how to obtain and measure these images. Representative images of normal pelvic anatomy, with select videos, are included to assist in understanding the presented concepts and normal anatomic images.
Topics: Female; Genitalia, Female; Humans; Pelvis; Rectum; Ultrasonography; Urinary Bladder; Urinary Tract
PubMed: 31677742
DOI: 10.1016/j.ogc.2019.06.001 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2017The pelvis is an anatomically complex and functionally informative bone that contributes directly to both human locomotion and obstetrics. Because of the pelvis'...
The pelvis is an anatomically complex and functionally informative bone that contributes directly to both human locomotion and obstetrics. Because of the pelvis' important role in obstetrics, it is one of the most sexually dimorphic bony elements of the human body. The complex intersection of pelvic dimorphism, locomotion, and obstetrics has been reenergized by exciting new research, and many papers in this special issue of the pelvis help provide clarity on the relationship between pelvic form (especially female) and locomotor function. Compared to the pelvis of our ape relatives, the human pelvis is uniquely shaped; it is superoinferiorly short and stout, and mediolaterally wide-critical adaptations for bipedalism that are already present in some form very early in the history of the hominin lineage. In this issue, 13 original research papers address the anatomy, development, variation, and function of the modern human pelvis, with implications for understanding the selection pressures that shaped and continue to shape this bone. This rich collection of scholarship moves our understanding of the pelvis forward, while raising dozens of new questions that we hope will serve as inspiration for colleagues and students (both current and future) puzzled by this fascinatingly complex bone. Anat Rec, 300:628-632, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Biological Evolution; Female; Humans; Locomotion; Parturition; Pelvic Bones; Pelvis; Pregnancy
PubMed: 28297176
DOI: 10.1002/ar.23561 -
European Journal of Radiology Sep 2020Penetrating abdominal trauma comprises a wide variety of injuries that will manifest themselves at imaging depending on the distinct mechanism of injury. The use of... (Review)
Review
Penetrating abdominal trauma comprises a wide variety of injuries that will manifest themselves at imaging depending on the distinct mechanism of injury. The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase in clinical practice allowing more patients to undergo initial selective non-surgical management. High diagnostic accuracy in this setting helps patients avoid unnecessary surgical intervention and ultimately reduce morbidity, mortality and associated medical costs. This review will present the evidence and the controversies surrounding the imaging of patients with penetrating abdominopelvic injuries. Available protocols, current MDCT technique controversies, organ-specific injuries, and key MDCT findings requiring intervention in patients with penetrating abdominal and pelvic trauma are presented. In the hemodynamically stable patient, the radiologist will play a key role in the triage of these patients to operative or nonoperative management.
Topics: Abdominal Injuries; Adult; Endovascular Procedures; Humans; Image Enhancement; Laparotomy; Multidetector Computed Tomography; Pelvis; Prognosis; Sensitivity and Specificity; Tomography, X-Ray Computed; Triage; Wounds, Gunshot; Wounds, Stab
PubMed: 32745896
DOI: 10.1016/j.ejrad.2020.109187 -
Anaesthesia, Critical Care & Pain... Apr 2019Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and... (Review)
Review
OBJECTIVE
Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject.
DESIGN
A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation; SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence; SFMU) in collaboration with the French Society of Radiology (Société Française de Radiologie; SFR), French Defence Health Service (Service de Santé des Armées; SSA), French Society of Urology (Association Française d'Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Société Française de Chirurgie Orthopédique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Société Française de Chirurgie digestive; SFCD) was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently from any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.
METHODS
Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology.
RESULTS
The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ).
CONCLUSIONS
Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.
Topics: Anesthesia; Critical Care; Fractures, Bone; Humans; Pelvis; Trauma Severity Indices; Wounds and Injuries
PubMed: 30579941
DOI: 10.1016/j.accpm.2018.12.003 -
International Journal of Gynaecology... Oct 2018Laparoscopy, with its many advantages, has revolutionized the field of pelvic surgery and enabled surgeons to gain a far greater understanding of pelvic anatomy. As...
Laparoscopy, with its many advantages, has revolutionized the field of pelvic surgery and enabled surgeons to gain a far greater understanding of pelvic anatomy. As technology evolves, our understanding is continuously improving. This article is a tribute to the anatomy of the pelvis, which itself has resisted evolutionary changes and remained the same, whereas our understanding of how to view and approach various organ structures has evolved.
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Medical Oncology; Pelvis
PubMed: 30306582
DOI: 10.1002/ijgo.12616 -
Journal of Minimally Invasive Gynecology Feb 2020To show how the evaluation for endometriosis can be included in the routine pelvic ultrasound examination.
STUDY OBJECTIVE
To show how the evaluation for endometriosis can be included in the routine pelvic ultrasound examination.
DESIGN
Stepwise narrated video demonstration of the sonographic evaluation for endometriosis in routine pelvic ultrasound following the recommended sonographic approach published in the 2016 consensus paper by the International Deep Endometriosis Analysis (IDEA) group [1].
SETTING
Endometriosis is a common and often debilitating gynecological disorder that affects 5-10% of women [2]. The prevalence is even higher among women with symptoms of endometriosis [2], which include chronic pelvic pain, acquired dysmenorrhea, dyspareunia, dyschezia, menorrhagia, abnormal bleeding, and infertility. Approximately 80% of women who have endometriosis have superficial lesions, whereas 20% have deep infiltrating endometriosis (DIE; [3]). Laparoscopy is the gold standard for diagnosing endometriosis, because it allows the diagnosis of all forms of endometriosis and often immediate removal of superficial endometriosis. The removal of DIE is considerably more complicated and usually cannot be completed unless it was diagnosed preoperatively. The technique to diagnose DIE with transvaginal ultrasound (TVUS) was first described in detail in 2009 [4]. Since then, the accuracy of TVUS for the prediction of DIE has been well established in the literature [5-7]. TVUS is widely used as a first-line investigation for women with gynecological symptoms. The inclusion of an assessment for endometriosis in the routine pelvic ultrasound allows earlier diagnosis and better surgical outcomes for all women with DIE.
INTERVENTIONS
The evaluation for endometriosis in routine pelvic ultrasound based on the IDEA consensus promotes a 4-step dynamic ultrasound approach [1]: (1) routine evaluation of uterus and adnexa with particular attention for sonographic signs of adenomyosis and the presence or absence of endometriomas; (2) evaluation of transvaginal sonographic 'soft markers' such as site-specific tenderness and ovarian mobility; (3) assessment of status of pouch of Douglas using the real-time ultrasound-based "sliding sign;" and (4) assessment of DIE nodules in the anterior and posterior compartments, which involves assessment of the bladder, vaginal vault, uterosacral ligaments, and bowel, including rectum, rectosigmoid junction, and sigmoid colon. Because 5-10% of women with DIE also have ureteric endometriosis, it is useful to assess the kidneys. Silent hydronephrosis is easily identified in 50-60% of patients with ureteric involvement. Although it is possible to identify DIE involving the ureters more directly, this requires more advanced skills, and further studies are still needed to better define the accuracy of ureteric DIE detection by TVUS [8-10].
CONCLUSION
Traditionally, only pathologies of the uterus and ovaries are assessed during a routine pelvic ultrasound. Here we demonstrate that the routine ultrasound examination can easily be extended beyond the uterus and ovaries into the posterior and anterior pelvic compartments to evaluate structural mobility and to look for deep infiltrating endometriotic nodules, wherewith women suffering from DIE can benefit from a preoperative diagnosis and subsequently, a single, well-planned procedure in the hands of a well-prepared team.
Topics: Diagnostic Techniques, Obstetrical and Gynecological; Diagnostic Tests, Routine; Endometriosis; Female; Humans; Pelvis; Peritoneal Diseases; Preoperative Care; Sensitivity and Specificity; Ultrasonography; Vagina
PubMed: 31493569
DOI: 10.1016/j.jmig.2019.08.027 -
Med (New York, N.Y.) May 2021Endometriosis has long been viewed as a pelvic disease. New evidence suggests that endometriosis is a systemic disease with multisystem involvement. A more comprehensive...
Endometriosis has long been viewed as a pelvic disease. New evidence suggests that endometriosis is a systemic disease with multisystem involvement. A more comprehensive understanding of endometriosis will speed recognition and clarify diagnosis. Treatments should target the broad manifestations of the disease rather than focus exclusively on the pelvic lesions.
Topics: Endometriosis; Female; Humans; Pelvis
PubMed: 35590229
DOI: 10.1016/j.medj.2021.04.026 -
Radiographics : a Review Publication of... Oct 2020Firearm-related injuries, or gunshot wounds (GSWs), are among the most important worldwide public health problems, resulting in considerable annual morbidity,... (Review)
Review
Firearm-related injuries, or gunshot wounds (GSWs), are among the most important worldwide public health problems, resulting in considerable annual morbidity, disability, and mortality. GSWs to the abdomen and pelvis are associated with substantial injuries to multiple organs and tissues. Imaging plays an important role in identifying these injuries, dictating nonoperative management, and determining imaging and clinical follow-up, as well as helping manage potential long-term complications. CT is the primary imaging modality used to evaluate these injuries and their complications, including use of reconstructed multiplanar volume-rendered images. The authors discuss the ballistics and mechanisms of firearm injury, CT findings, trajectory analysis, and applications of different imaging modalities above and beyond CT in evaluation of GSWs. Imaging findings and classifications of the severity of injuries to solid and hollow organs and vascular, musculoskeletal, and neurologic systems are reviewed. Key complications associated with gunshot injuries to the abdomen and pelvis are presented. The challenges of imaging in the acute trauma setting and potential pitfall mimics at imaging, particularly at CT, are also described. A step-by-step guide for thorough and comprehensive evaluation of GSWs to the abdomen and pelvis is introduced, with tips for optimizing effective communication with the clinical team. RSNA, 2020.
Topics: Abdominal Injuries; Humans; Pelvis; Wounds, Gunshot
PubMed: 33001782
DOI: 10.1148/rg.2020200018