OB-GYN-L Messages for September, 2000: Re: Postmenopausal Bleeding

Re: Postmenopausal Bleeding

From: art fougner, md

evsono@pipeline.com

Tue Sep 26 07:42:41 2000

to amplify - i have found patients in whom the pathology could only be demonstrated via abdominal views = "floating ovaries", ectopics, large fibroids, etc beyond the focal range of the vaginal transducer. possibly the most difficult patients to image vaginally are many women who've had c-sections - the uterus is pulled up a bit high for TVS yet no matter how full the bladder, TA views are suboptimal as well. something about the low flap incision which encourages adhesion between the bladder and the LUS. in any event, for most cases supplemental empty bladder TA views usually suffice with TVS being the primary approach. the distinction between TA and TV should be regarded as totally artificial - the idea is to arrive at the information sufficient to help solve a clinical problem. it is the situation and the individual patient, not the cpt code book or the insurance carrier which should dictate what ultimately gets done.

of course, that's just my opinion - i could be wrong.

art

At Mon, 25 Sep 2000, Zach Newton wrote: >
>> At Sat, 23 Sep 2000, Larry Glazerman wrote:
>
>>The radiologists in my area still insist on doing transabdominal US >with TV- they will not to TV alone. For those patients whose >insurance won't let me do the ultrasound, that's what we have to >put up with. They do a TA scan then empty the bladder for the TV >scan
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>
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>It seems from the series of posts in this sub-thread that the above
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>characterizes the pratice of radiologists around the globe.
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>
>It is exactly our experience, as well.
>
>With a fulltime RDMS sonographer, our practice has been performing in
>house pelvic sonography for 20 years (now 7 M.D.'s/4 CNM's).
>It has been exceedingly rare that TA has been needed beyond TV in the
>many years since TV probe was first acquired for capturing the images
>needed in gyn application.
>
>When ouside imaging for gyn is requested, the reports received from
>radiologists when TV only was specified have been terse and with much
>disclaimer attached.
>
>A potential strategy that I have not used, but plan to test, is a TV w/
>reflex TA if specifically indicated. This approach does create a
>logistical problem IRT the full bladder issue. Cath and saline bladder
>filling has its own problems. It would be anticipated that the judgment
>by radiologist for a need for reflex TA would be quite high. Maybe the
>cath and saline filling would create enough hassle factor that the
>radiologists would find less need to perform superfluous TA scans.
>
>Art, thanks for J Ultrasound Med 2000 Apr article. That does represent
>credible evidence for what is being discussed in this thread.
>
>--
>Zach Newton
>Z. B. Newton, III, M.D.
>Atlanta/Gyn
>

-- art fougner, md

A series of 1000 cases begins with but a single anecdote.

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