Superhuman view of the sonotarget: the ovaries
The ovaries, much like the CBD, may at first seem to pose a problem to students. It doesn’t seem that there is much to govern their location–like other organs that must stay put, instead, they seem to be indulgent in swinging around on their adnexal ligaments exercising their liberty of locomotion. In fact, you might make note of where you see one in transabdominal views and see where is is post void in transvaginal–prolly not the same spot–so this ability, coupled with gas from the bowels makes you feel like you’re playing a game of marco-polo in mud, right?
Well, there actually is a trick based on anatomical anchoring of the ovary that will lead you to it every time. The adnexal ligaments–yep, you can see them on ultrasound, and you can use them like a little trail of popcorn to find the object of desire; the slippery sneaky ovary.
You need to first see the adnexal ligaments as an extension of the uterus–at the end of this rainbow will be your pot o gold–the ovaries.You see how the round ligament, tube, and adnexal vessels all wrap up together, and surround the ovary.
Uterus and adnexae
The best way to see this with ultrasound in both transabdominal and transvaginal views is in transverse. So you go TRV, start inferiorly and scan upward toward the fundus, you will see the pinched look of the ligament arising from the periphery of the fundus like a tuft of hair. Now it wont always be straight, so just keep it in the picture until you run into the target; the Ovary—TA DA!!
Sometimes gas can interfere with keeping the ligaments in view, so while you make your slow sweep out into the adnexa, wiggle your probe a tiny bit back and forth, like millimeters–dont creep out your patient–and that will cause the gas to disperse a bit. Once you have the ovary in transverse, apply a bit of pressure while you turn your probe for sagittal images. See? Not so tough.
ultrasound tips & tricks 
Reblogged this on ultrasound tips & tricks.
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