Sliding organs sign in gynecological ultrasound.

Among the virtues of transvaginal ultrasound are two that are less well known and hence less frequently applied. Touching an area with the probe and testing for pain is one. The other is the ‘sliding organs sign’, whose use in a variety of gynecological diseases has been suggested lately in several articles1–8. Applying pressure with the tip of the transvaginal ultrasound probe under real-time vision makes it possible to see the sliding of the cervix, the uterine fundus, the ovaries and their possible pathologies relative to the static pelvic wall or the intestines. I do not place any proprietary claim on the term ‘sliding organs sign’ and have never published a peer-reviewed article or study about it. For the record, however, I would like to ensure that my original and first description of the above sign, made 27 years ago, is not forgotten. It was published in 1988 in the first edition of my book, Transvaginal Sonography, co-edited with Dr Shraga Rottem9. The pertinent paragraph, on page 24 of the book, reads: ‘Diagnosis of pelvic adhesions becomes possible by the ‘‘sliding organs sign’’. The transducer tip is pointed at the uterus, ovaries or any pelvic finding (e.g. ovarian mass, tubo-ovarian complex), and a gentle push-pull movement of several centimeters is started. If no adhesions are present, the organs will move freely in the pelvis. This displacement of organs is perceived on the screen as a sliding movement. One may, for instance, observe the free sliding of an ovarian mass over the lateral wall of the pelvis, which of course is static. In the case of a tubo-ovarian complex, the relative locations of the uterus, tube, and ovary will not change under the pushing of the probe, because of extensive adhesions preventing normal and physiological sliding of these organs’9. In the same book, the ‘sliding organs sign’ is further detailed on pages 35, 52, 55, 72 and 84, regarding its application contributing to the diagnosis of different pathologies. In the second edition of the book with the same title, this sign was also mentioned in several places10. I feel that this was an important observation in the early application of transvaginal ultrasound and, because of its simplicity and its self-evident nature, its value over the last two decades has been recognized independently by multiple operators. Inasmuch as I would like this observation to be remembered as ‘Timor’s sliding organs sign’, I feel at peace