101 video cases
Training your eye and improving pattern recognition
We have recorded 101 ‘live’ video cases to help you train your eye. There are 2 copies of each scan. The first one is silent while the second one has descriptive narration. You can watch the first one to see what pathology you recognise and check yourself by watching the second one.
All scans are quite fast paced 3-4 minute clips taken when we go check the sonographer’s scan. The focus is not on optimising the image quality as much as possible but the focus is on showing you a lot of pathology in a relatively short time to improve pattern recognition. The purpose is to show you that within a relatively short time frame you can get a good idea about the presence of deep endometriosis, even if the time allocation at your practice does not allow time for a full assessment.
The first section just contains normal scans to show how to extend the ‘routine’ gynaecological ultrasound into the anterior and posterior compartment, when the uterus is anteverted as well as retroverted.
We recommend then looking at the second section to learn how to recognise moderate to severe endometriosis and keeping subtle lesions till last as this is clinically least important and subtle lesions require more expertise to get it right.
The last section allows you to test yourself. There is no second video with explanatory commentary but you can send us your diagnosis and we will send you a link to the narrated videos.
You can watch some cases below but there are many many more !!
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As a member you can also ask questions, share experiences or even submit your own images and videos for further discussion.
Normal scans
These scans are examples of the ‘new’ routine gynaecological ultrasound. Endometriosis is a common condition and often a gynaecological ultrasound is the first line of investigation. If not only the uterus, the endometrium and the ovaries are assessed in every routine scan, but also the bladder, pouch of Douglas, sliding sign, uterosacral ligaments and bowel, then all women with deep endometriosis have a chance of a preoperative diagnosis. These examples will highlight that this does not have to take much time.
Anteverted versus retroverted uterus
The diagnosis of deep endometriosis in the pouch of Douglas is easier when the uterus is in an anteverted position as the sliding sign is easier to demonstrate and uterosacral ligaments are easier to identify. When the uterus us retroverted, the pouch of Douglas and sliding sign are more difficult to assess. The normal cases are worth watching as they show some tricks on how to perform that assessment.
Moderate to severe endometriosis
Moderate to severe endometriosis can be really tricky to fully document. The main aim of the routine gynaecological scan should be to recognise its presence by looking in the anterior and posterior compartment so the patient can be referred for a further specialist assessment if she is considering surgery. Diagnosis of possible endometriosis is important for patients to understand why they have symptoms but not all women will have surgery. Many will try hormonal options first. Don’t beat yourself up if you can not do the whole assessment as described in the IDEA consensus. Just recognising that disease is present has helped your patient forward enormously as she will be able to have a more detailed assessment preoperatively, giving her a better chance at avoiding delayed diagnosis or repetitive surgery.
Subtle lesions
Subtle lesions are the hardest to diagnose correctly. Often you may have the impression that you see small nodules everywhere but initially there is a high chance that these are false positives. If you make a habit of looking in the pouch of Douglas during every scan, you will become better and better at recognising these little lesions. Keep in mind however that the small nodules are scarring. We can not actually see the endometrial glands within the nodule. Small nodules can have other causes. Previous pelvic surgery, infection, past history of removal of endometriosis, and maybe even oocyte pick up for IVF. If it is focally tender, reporting it as a possibility, not a certainty, is not unreasonable but follow up and obtaining feedback is crucial in improving your diagnosis.
TEST YOURSELF
We have selected 10 cases that allow you to test yourself. Feel free to try them before doing the lectures and looking at all cases, and again after you go through all the material on this site. We would love to hear if you have improved you recognition of disease. You can download an answer sheet and email it to us once you have filled it out. We will send you a link with the answers.