Diagnostic Ultrasound - Abdomen and Pelvis

Solid Adnexal Mass
– May masquerade as solid lesion when acute
– Clues to diagnosis are increased through transmission
and lack of blood flow within lesion
– Short-term follow-up often required and will show
rapid change in appearance of blood products
○ Endometrioma
– May be echogenic and mimic solid mass, especially if
gain high
– Should have no color Doppler flow except for wall
○ Obstructed Uterine Duplication
– Look for deviation of uterus/endometrial stripe away
from side of obstructed horn
– Look for duplication of cervix
○ Pelvic Kidney
– Look for reniform shape, corticomedial
differentiation, collecting system, and ipsilateral
empty renal fossa
• Primary Ovarian Malignancy
○ May have other signs of malignancy such as ascites,
omental thickening, serosal metastases on liver &/or
spleen
○ Endometrioid carcinoma
– 30% are bilateral
– Typical mixed cystic and solid adnexal mass but may
appear solid
– Associated with endometriosis in 15-20%
Helpful Clues for Rare Diagnoses
• Ovarian Lymphoma
○ Most cases of ovarian involvement are in patients with
systemic disease
○ Primary ovarian lymphoma is rare
○ Homogeneous, bilateral, solid masses with lack of ascites
• Tubo-Ovarian Abscess
○ Patient with pelvic pain, vaginal discharge, elevated
white blood cell count
• Tubal Carcinoma
○ May be associated with hydrosalpinx
○ Seen between uterus and ovary
○ Tube may be dilated containing tubular-shaped, solid
mass
○ Often advanced and indistinguishable from primary
ovarian carcinoma
• Luteoma of Pregnancy
○ Solid, ovarian, nonneoplastic mass that occurs during
pregnancy
○ Elevated androgen levels
○ Regresses postpartum
• Adenofibroma
○ Fibrous lesion with shadowing
• Granulosa Cell Tumor
○ Due to estrogen secretion, associated with
postmenopausal bleeding and precocious puberty,
depending on patient age
• Brenner Tumor
○ Almost always benign
○ May have calcifications
• Massive Ovarian Edema and Fibromatosis
○ MOE: Tumor-like ovarian enlargement secondary to
edema
○ OF: Tumor-like ovarian enlargement due to fibromatous
growth of ovarian stroma
Alternative Differential Approaches
• Patient age/menstrual status aids in differential diagnosis
○ Prepubertal girls
– Granulosa cell tumor
– Germ cell tumor
– Immature teratoma, ovary
○ Reproductive age
– Leiomyoma, subserosal
– Dermoid (mature teratoma)
– Primary ovarian malignancy
– Ovarian fibroma
○ Postmenopausal
– Ovarian fibroma
– Primary ovarian malignancy
– Metastases, ovary
– Leiomyoma
Differential Diagnoses: Female Pelvis
Leiomyoma
Leiomyoma
(Left) Transverse color
Doppler US shows
heterogeneous right adnexal
hypoechoic mass (calipers).
Note the vascular supply ſt
running within the stalk
arising from the anterior
uterine fundus st, typical of a
pedunculated fibroid. (Right)
Longitudinal endovaginal US
in a 41-year-old woman with
known fibroids shows a
hypoechoic adnexal mass ſt
adjacent to, but separate from
the right ovary st. Edge
shadowing from the mass is
seen through the ovary in the
far field .
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