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24-06: Suprapubic

Jeremy S. Boyd; Myles Melton; Jordan D. Rupp; Robinson M. Ferre

Technique

Sagittal View (Longitudinal)

  • With the indicator oriented toward the patient’s head, the transducer is placed just above the symphysis pubis and is directed into the pelvis (Fig. 24.17).

  • Identify the bladder (triangular in this view when fully distended), uterus (pear-shaped if present), prostate, seminal vesicles, and rectum (Figs. 24.18 and 24.19).

FIGURE 24.17

Suprapubic Sagittal View. The transducer indicator is oriented toward the patient’s head and the transducer is placed just above to the symphysis pubis and is directed into the pelvis. (Photo contributor: Lawrence B. Stack, MD.)

A patient lies in the supine position. A practitioner places the flat side of the on the abdomen just below the navel to get a Suprapubic Sagittal View.
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FIGURE 24.18

Normal Male Pelvis, Sagittal View. The bladder appears triangular in this view. The prostate and seminal vesicles can be seen to the right of the screen, just deep to the bladder. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Jeremy S. Boyd, MD.)

An ultrasound image of a Sagittal View of a normal Male Pelvis shows the bladder at the center. At its bottom right is the prostrate and small seminal vesicles. On the left is the bulbous small bowel and the colon is at the bottom of the image. A green dot is outside the image at the top left. An illustration depicts an ultrasound image of a Sagittal View of a normal Male Pelvis.
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An ultrasound image of a Sagittal View of a normal Male Pelvis shows the bladder at the center. At its bottom right is the prostrate and small seminal vesicles. On the left is the bulbous small bowel and the colon is at the bottom of the image. A green dot is outside the image at the top left. An illustration depicts an ultrasound image of a Sagittal View of a normal Male Pelvis.
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FIGURE 24.19

Normal Female Pelvis, Sagittal View. The uterus appears pear-shaped in this view, and may be anteroflexed or retroflexed. The “pouch of Douglas” is a potential space between the uterus and the rectum, and is deep to the uterus. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Jeremy S. Boyd, MD.)

An ultrasound image shows a Sagittal View of a normal female Pelvis. The bladder is at the top right, with the uterus below and to the left. The small bowel is to the left and the colon is at the bottom of the image. A green dot is outside the image at the top left. An illustration depicts a Sagittal View ultrasound of a normal female pelvis.
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An ultrasound image shows a Sagittal View of a normal female Pelvis. The bladder is at the top right, with the uterus below and to the left. The small bowel is to the left and the colon is at the bottom of the image. A green dot is outside the image at the top left. An illustration depicts a Sagittal View ultrasound of a normal female pelvis.
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Technique: Transverse View

  • With the indicator oriented toward the patient’s right, the transducer is placed about 1 to 2 cm above the symphysis pubis and the beam is angled through the bladder into the peritoneum (Fig. 24.20).

  • Identify the bladder (rectangular in this view when fully distended), uterus (oval hyperechoic structure if present), prostate, seminal vesicles, and rectum (Fig. 24.21).

FIGURE 24.20

Suprapubic View, Transverse. The indicator is oriented to the patient’s right and the beam angled through the bladder into the peritoneum. (Photo contributor: Lawrence B. Stack, MD.)

A patient lies supine. A practitioner places the flat end of the transducer on the abdomen just below the navel to get a Transverse Suprapubic view.
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FIGURE 24.21

Suprapubic View, Transverse. The bladder appears rectangular in this view. The uterus/cervix or prostate/seminal vesicles can be seen deep to the bladder. (Ultrasound contributor: Jeremy S. Boyd, MD.)

An ultrasound image shows a Transverse Suprapubic view of the bladder. The bladder appears as a dark rectangle at the center of the image.
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Abnormal Findings

  • Hemoperitoneum (male pelvis): Free fluid in the male pelvis is seen as anechoic (black) areas filling the rectovesicular space, the potential space between the bladder and the rectum. The rectovesicular space is immediately cephalad to the extraperitoneal prostate and seminal vesicles. In the sagittal view, it is easier to see this junction that distinguishes the peritoneal cavity from the extraperitoneal pelvis. A large amount of free fluid may appear ...

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