Diagnostic Ultrasound - Abdomen and Pelvis

Solid Adnexal Mass
Fibrothecoma
Hemorrhagic Ovarian Cyst
(Left) Longitudinal
endovaginal US shows a
homogeneous hypoechoic
mass (calipers) with posterior
acoustic shadowing. While it
resembles a leiomyoma, there
is no stalk connecting the
mass to the uterus/cervix st.
(Right) Longitudinal
endovaginal US in a 22-yearold
woman with acute pelvic
pain shows a large,
heterogenous adnexal mass
ſt. Large-volume echogenic
pelvic free fluid st indicates a
ruptured hemorrhagic cyst.
Lack of Doppler flow centrally
is useful in distinguishing this
from a solid mass.
Differential Diagnoses: Female Pelvis
Endometrioma
Endometrioma
(Left) Longitudinal
endovaginal US in this
asymptomatic woman shows a
homogeneous small ovarian
mass ſt. Lack of Doppler flow
(not shown) and homogeneous
echoes are typical of an
endometrioma. (Right)
Transverse endovaginal US
shows a large, hyperechoic
adnexal mass ſt. While
Doppler flow will be seen in
the wall, there should be no
flow centrally, helping to
distinguish this from a solid
mass. Occasionally,
endometriomas appear
hyperechoic, which may in
part be technical (↑ gain).
Endometrioid Carcinoma
Tubo-Ovarian Abscess
(Left) Transabdominal US
shows a cystic and solid
adnexal mass ſt with Doppler
flow. The presence of a solid
mass, aside from findings of
carcinomatosis, is the most
specific finding of ovarian
carcinoma. (Right) Coronal
endovaginal color Doppler US
of the right adnexa shows the
right ovary with adjacent
avascular hypoechoic mass
with mixed solid and cystic
areas ſt representing small
pockets of pus and fibrin
strands.
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