Skip to main content
SpringerLink
Log in

Ultrasonographic and multimodal imaging of pediatric genital female diseases

  • Review article
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Ultrasonography is the first-line imaging modality in the evaluation of the female pelvis in childhood and adolescence, because it is easy to perform, non-invasive and it does not require sedation. The transabdominal approach is preferred in children and adolescents, after filling the bladder to move away the bowel loops from the pelvis. The probe frequency must be adapted to age, thickness of tissues and depth of the structures under examination. High-frequency (4-12 MHz) linear or convex probes are used in newborns; high-frequency linear probes (4-12 MHz) in toddler, convex 5-7.5 MHz probes in girls and convex 3.5-5 MHz probes in teenagers. In this article, the main pathological conditions of the genital female tract in pediatric age are examined, such as congenital anomalies, disorders of sex development, ovarian cysts, ovarian tumors, adnexal torsion, primary amenorrhea, precocious puberty and pelvic inflammatory disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19

Similar content being viewed by others

References

  1. Busilacchi P, Rapaccini GR et al (2006) Ecografia Clinica. Idelson Casa Editrice

  2. Siegel MJ (2011) Pediatric sonography. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  3. Beek E, Van Rijn RR (2016) Diagnostic pediatric ultrasound. Thieme, New York

    Book  Google Scholar 

  4. Paltiel HJ, Phelps A (2014) US of the pediatric female pelvis. Radiology 270(3):644–657

    Article  Google Scholar 

  5. Garel L, Dubois J, Grignon A, Filiatrault D, Van Vliet G (2001) US of the pediatric female pelvis: a clinical perspective. Radiographics 21(6):1393–1407

    Article  CAS  Google Scholar 

  6. Cacciatore B, Leminen A, Ingman-Friberg S, YlÖstalo P, Paavonen J (1992) Transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease. Obstet Gynecol 80(6):912–916

    CAS  PubMed  Google Scholar 

  7. Taipale P, Tarjanne H, Ylostalo P (1995) Transvaginal sonography in suspected pelvic inflammatory disease. Ultrasound Obstet Gynecol 6(6):430–434

    Article  CAS  Google Scholar 

  8. Teele RL, Share JC (1997) Transperineal sonography in children. AJR Am J Roentgenol 168(5):1263–1267

    Article  CAS  Google Scholar 

  9. Orsini LF, Salardi S, Pilu G, Bovicelli L, Cacciari E (1984) Pelvic organs in premenarcheal girls: real-time ultrasonography. Radiology 153(1):113–116

    Article  CAS  Google Scholar 

  10. Forrest TS, Elyaderani MK, Muilenburg MI, Bewtra C, Kable WT, Sullivan P (1988) Cyclic endometrial changes: US assessment with histologic correlation. Radiology 167(1):233–237

    Article  CAS  Google Scholar 

  11. Cohen HL, Shapiro MA, Mandel FS, Shapiro ML (1993) Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old. AJR Am J Roentgenol 160(3):583–586

    Article  CAS  Google Scholar 

  12. Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG (2012) Imaging of the female pelvis through the life cycle. Radiographics 32(6):1575–1597

    Article  Google Scholar 

  13. Laufer M (2012) Structural abnormalities of the female reproductive tract. In: Emans SJ, Laufer MR (eds) Pediatric and adolescent gynecology, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 188–237

    Google Scholar 

  14. Buttram VC (1983) Müllerian anomalies and their management. Fertil Steril 40(2):159–163

    Article  Google Scholar 

  15. Grimbizis GF et al (2013) The ESHRE–ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg 10(3):199–212

    Article  Google Scholar 

  16. Oppelt P, Renner SP, Brucker S et al (2005) The VCUAM (Vagina Cervix Uterus Adnex–associated Malformation) Classification: a new classification for genital malformations. Fertil Steril 84(5):1493–1497

    Article  Google Scholar 

  17. Junqueira BL, Allen LM, Spitzer RF, Lucco KL, Babyn PS, Doria AS (2009) Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics 29(4):1085–1103

    Article  Google Scholar 

  18. Brody JM, Koelliker SL, Frishman GN (1998) Unicornuate uterus: imaging appearance, associated anomalies, and clinical implications. AJR Am J Roentgenol 171(5):1341–1347

    Article  CAS  Google Scholar 

  19. Gibson ED (2003) Transverse upper vaginal septum presenting in pregnancy: a case report and review of the literature. Aust N Z J Obstet Gynaecol 43(5):381–383

    Article  Google Scholar 

  20. Posner JC, Spandorfer PR (2005) Early detection of imperforate hymen prevents morbidity from delays in diagnosis. Pediatrics 115(4):1008–1012

    Article  Google Scholar 

  21. Brosens I, Gordts S, Benagiano G (2013) Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 28(8):2026–2031

    Article  CAS  Google Scholar 

  22. Jaramillo D, Lebowitz RL, Hendren WH (1990) The cloacal malformation: radiologic findings and imaging recommendations. Radiology 177(2):441–448

    Article  CAS  Google Scholar 

  23. Lee PA, Houk CP, Ahmed SF, Hughes IA (2006) Consensus statement on management of intersex disorders. Pediatrics 118(2):e488–e500

    Article  Google Scholar 

  24. Pasterski V, Prentice P, Hughes IA (2010) Consequences of the Chicago consensus on disorders of sex development (DSD): current practices in Europe. Arch Dis Child 95(8):618–623

    Article  CAS  Google Scholar 

  25. Orazi C, Cappa M, Schingo PM, Tomà P (2012) Ambiguous genitalia. In: Imaging endocrine diseases in children. Springer, Berlin, pp 81–109

  26. Chavhan GB, Parra DA, Oudjhane K, Miller SF, Babyn PS, Pippi Salle FL (2008) Imaging of ambiguous genitalia: classification and diagnostic approach. Radiographics 28(7):1891–1904

    Article  Google Scholar 

  27. Ben-Ami I, Kogan A, Fuchs N et al (2010) Long-term follow-up of children with ovarian cysts diagnosed prenatally. Prenat Diagn 30(4):342–347

    PubMed  Google Scholar 

  28. Kwak DW, SohnYS Kim SK, Kim IK, Park YW, Kim YH (2006) Clinical experiences of fetal ovarian cyst: diagnosis and consequence. J Korean Med Sci 21(4):690–694

    Article  Google Scholar 

  29. Cohen HL, Eisenberg P, Mandel F, Haller JO (1992) Ovarian cysts are common in premenarchal girls: a sonographic study of 101 children 2–12 years old. AJR Am J Roentgenol 159(1):89–91

    Article  CAS  Google Scholar 

  30. Barber HRK (1986) Ovarian Cancers. CA Cancer J Clin 36:149–184

    Article  CAS  Google Scholar 

  31. Von Allmen D (2005) Malignant lesions of the ovary in childhood. Semin Pediatr Surg 14(2):100–105

    Article  Google Scholar 

  32. De Silva KSH, Kanumakala S, Grover SR, Chow CW, Warne GL (2004) Ovarian lesions in children and adolescents-an 11-year review. J Pediatr Endocrinol Metab 17(7):951–958

    Article  Google Scholar 

  33. Lucchetti MC, Orazi C (2011) Neoformazioni ovariche, ch 10. In: Bruni V, Dei M (eds) Ecografia in ginecologia dell’infanzia e dell’adolescenza. CIC Edizioni Internazionali

  34. Allen BC, Hosseinzadeh K, Qasem SA, Varner A, Leyendecker JR (2014) Practical approach to MRI of female pelvic masses. Am J Roentgenol 202(6):1366–1375

    Article  Google Scholar 

  35. Pai DR, Ladino-Torres MF (2013) Magnetic resonance imaging of pediatric pelvic masses. Magn Reson Imaging Clin 21(4):751–772

    Article  Google Scholar 

  36. Siegel MJ (2002) Magnetic resonance imaging of the adolescent female pelvis. Magn Reson Imaging Clin 10(2):303–324

    Article  Google Scholar 

  37. Epelman M, Chikwava KR, Chauvin N, Servaes S (2011) Imaging of pediatric ovarian neoplasms. Pediatr Radiol 41(9):1085

    Article  Google Scholar 

  38. Heo SH et al (2014) Review of ovarian tumors in children and adolescents: radiologic-pathologic correlation. Radiographics 34(7):2039–2055

    Article  Google Scholar 

  39. Anthony EY, Caserta MP, Singh J, Chen MY (2012) Adnexal masses in female pediatric patients. Am J Roentgenol 198(5):W426–W431

    Article  Google Scholar 

  40. Shah RU, Lawrence C, Fickenscher KA, Shao L, Lowe LH (2011) Imaging of pediatric pelvic neoplasms. Radiol Clin 49(4):729–748

    Article  Google Scholar 

  41. Amies Oelschlager AM, Sawin R (2012) Teratomas a46nd ovarian lesions in children. Surg Clin 92(3):599–613

    Article  Google Scholar 

  42. Wexler LH, Meyer WH, Helman LJ (2006) Rhabdomyosarcoma and the undifferentiated sarcomas. In: Pizzo PA, Poplack DG (eds) Principles and practice of pediatric oncology, 5th edn. Lippincott Williams and Wilkins, Philadelphia, pp 971–1001

    Google Scholar 

  43. Agrons GA, Wagner BJ, Lonergan GJ, Dickey GE, Kaufman MS (1997) From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic–pathologic correlation. Radiographics 17(4):919–937

    Article  CAS  Google Scholar 

  44. Tannous WN, Azouz EM, Homsy YL, Kiruluta HG, Grattan-Smith D (1989) CT and ultrasound imaging of pelvic rhabdomyosarcoma in children. Pediatr Radiol 19(8):530–534

    Article  CAS  Google Scholar 

  45. Fernandez-Pineda I, Spunt SL, Parida L, Krasin MJ, Davidoff AM, Rao BN (2011) Vaginal tumors in childhood: the experience of St. Jude Children’s Research Hospital. J Pediatr Surg 46(11):2071–2075

    Article  Google Scholar 

  46. Appelbaum H, Abraham C, Choi-Rosen J, Ackerman M (2013) Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol 26(3):167–170

    Article  Google Scholar 

  47. Rossi BV, Ference EH et al (2012) The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 25(2):109–113

    Article  Google Scholar 

  48. Orazi C, Lucchetti MC (2011) La diagnosi ecografica nelle urgenze addominali nell’infanzia, ch 11. In: Bruni V, Dei M (eds) Ecografia in ginecologia dell’infanzia e dell’adolescenza. CIC Edizioni Internazionali

  49. Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS (2007) Sonographic findings of ovarian torsion in children. Pediatr Radiol 37(5):446–451

    Article  Google Scholar 

  50. Shadinger LL, Andreotti RF, Kurian RL (2008) Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 27(1):7–13

    Article  Google Scholar 

  51. Graif M, Itzchak Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. Am J Roentgenol 150(3):647–649

    Article  CAS  Google Scholar 

  52. Kim J, Park D, Han WB, Jeong H, Park Y (2014) Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament. Obstet Gynecol Sci 57(4):338–341

    Article  Google Scholar 

  53. Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Am J Roentgenol 198(2):W122–W131

    Article  Google Scholar 

  54. Blank SK, Helm KD, McCartney CR (2008) Polycystic ovary syndrome in adolescence. Ann N Y Acad Sci 1135:76–84

    Article  CAS  Google Scholar 

  55. Azziz R, Carmina E, Dewailly D et al (2006) Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metab 91(11):4237–4245

    Article  CAS  Google Scholar 

  56. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 Consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81(1):19–25

    Article  Google Scholar 

  57. Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group (2012) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS) The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Hum Reprod 27(1):14–24

    Article  Google Scholar 

  58. Mansfield MJ (2012) Precocious puberty. In: Emans SJ, Laufer MR (eds) Pediatric and adolescent gynecology, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 114–124

    Google Scholar 

  59. Carel JC, Leger J (2008) Precocious puberty. N Engl J Med 358(22):2366–2377

    Article  CAS  Google Scholar 

  60. Shrier LA (2012) Sexually transmitted infections: chlamydia, gonorrhea, pelvic inflammatory disease, and syphilis. In: Emans SJ, Laufer MR (eds) Pediatric and adolescent gynecology, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 325–348

    Google Scholar 

  61. Orazi C, Lucchetti MC, Silveri M, Marchetti P, Nallo S, Tomà P (2014) Approccio alla patologia della salpinge in età pediatrica Il Giornale italiano di. Radiologia 1:918–930

    Google Scholar 

  62. Timor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS (1998) Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol 12(1):56–66

    Article  CAS  Google Scholar 

  63. Okaro E, Valentin L (2004) The role of ultrasound in the management of women with acute and chronic pelvic pain. Best Pract Res Clin Obstet Gynaecol 18(1):105–123

    Article  Google Scholar 

  64. Cicchiello LA, Hamper UM, Scoutt LM (2011) Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin N Am 38(1):85–114

    Article  Google Scholar 

  65. Nalaboff KM, Pellerito JS et al (2001) Imaging the endometrium: disease and normal variants. Radiographics 21(6):1409–1424

    Article  CAS  Google Scholar 

  66. Gupta A, Desai A et al (2017) Imaging of the endometrium: physiologic changes and diseases: women’s imaging. RadioGraphics 37(7):2206–2207

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Biostructure and Bioimaging National Research Council, Via Tommaso De Amicis, 95, 80145, Naples, Italy

    Maria Grazia Caprio

  2. Radiology Department, “Antonio Cardarelli” Hospital, Naples, Italy

    Marco Di Serafino

  3. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy

    Alessia De Feo, Elvira Guerriero & Teresa Perillo

  4. Radiology Department, Umberto I Hospital, Nocera Inferiore, Salerno, Italy

    Luigi Barbuto

  5. Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy

    Norberto Vezzali & Federica Ferro

  6. Radiology Department, “Santobono-Pausilipon” Children Hospital, Naples, Italy

    Eugenio Rossi

  7. Paediatric Radiology Department, “Federico II” University Hospital, Naples, Italy

    Gianfranco Vallone

  8. Department of Imaging, Bambino Gesù Children’s Hospital Research Institute, P.za S.Onofrio 4, Via Torre di Palidoro, Palidoro, Rome, Italy

    Cinzia Orazi

Authors
  1. Maria Grazia Caprio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Di Serafino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessia De Feo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elvira Guerriero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teresa Perillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luigi Barbuto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norberto Vezzali
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eugenio Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Federica Ferro
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gianfranco Vallone
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Cinzia Orazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Grazia Caprio.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and its later amendments.

Human and animal rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent

Additional informed consent was obtained from all the patients for whom identifying information is not included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caprio, M.G., Di Serafino, M., De Feo, A. et al. Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound 22, 273–289 (2019). https://doi.org/10.1007/s40477-019-00358-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-019-00358-5

Keywords

Search

Navigation