Diagnostic Ultrasound - Abdomen and Pelvis

Enlarged Ovary
– Often bilateral (50%)
○ Cystadenofibroma
– Benign cystic adnexal mass
– Uni- or multilocular
– Unilocular with 1 or more small, shadowing, avascular,
hyperechoic mural nodules in majority
• Ovarian Hyperstimulation
○ Occurs in setting of ovulation induction
○ Range of clinical severity from mild to severe requiring
ICU support
○ Bilateral enlarged ovaries with multiple cysts
– > 5-10 cm ovarian diameter
– Spoke wheel configuration
– Cysts may be simple or complex if hemorrhagic
component present
○ Ascites, pleural effusions, hemoconcentration, oliguria
• Theca Lutein Cysts
○ Enlarged ovaries with multiple cysts
○ Typically bilateral
○ Thin septa between simple cysts
– May be complex cysts from hemorrhage
○ Typically occurs in few clinical scenarios with common
etiology of ↑ human chorionic gonadotropin
– Multiples
– Gestational trophoblastic disease
– Triploidy (partial mole)
– Fetal hydrops (immune type)
○ PCOS may predispose
• Tubo-Ovarian Abscess
○ Thickened Fallopian tubes containing fluid, often
echogenic (pus)
○ Complex fluid collection with thick hypervascular wall,
septa, echogenic debris
○ Tube often coiled around abscess
– Best appreciated with cine sweep imaging
○ Pain, fever, and leukocytosis
Helpful Clues for Rare Diagnoses
• Malignant Masses
○ Ascites often present
○ Ovarian cancer usually presents with advanced disease,
stage III or IV
○ Ovarian cystadenocarcinoma: Complex cystic and solid
mass, large, often bilateral
– Borderline tumors may present as unilocular cyst with
papillary projections/mural nodules
○ Ovarian metastases: Bilateral cystic &/or solid masses
most often occurring in setting of known malignancy
– Most often gastric, colon, pancreas, breast carcinomas
• Massive Ovarian Edema (MOE) and Ovarian Fibromatosis
(OF)
○ MOE: Tumor-like ovarian enlargement secondary to
edema
○ OF: Tumor-like ovarian enlargement due to fibromatous
growth of ovarian stroma
○ Both conditions are usually unilateral
○ Diffuse ovarian enlargement with maintained ovarian
configuration
– MOE: Enlarged ovary with edematous appearance
and peripheral follicles
– OF: Enlarged ovary with segmental or peripheral areas
of T1 and T2 low signal intensity
Alternative Differential Approaches
• Preserved ovarian architecture
○ PCOS
○ Functional Ovarian cyst
○ Hemorrhagic cyst
○ Corpus luteum/corpus luteal cyst
○ Adnexal torsion
○ Ovarian hyperstimulation
○ Theca lutein cysts
○ MOE and OF
• Enlarged ovary with altered architecture
○ Benign masses
○ Tubo-ovarian abscess
○ Malignant masses
Differential Diagnoses: Female Pelvis
Polycystic Ovarian Syndrome (PCOS)
Hemorrhagic Cyst
(Left) Longitudinal
endovaginal US shows an
enlarged ovary with a length
of 4.4 cm and a volume of 19
mL. Note the echogenic
stroma and multiple small
(< 1 cm) peripheral follicles
. (Right) Transverse
endovaginal color Doppler US
of an enlarged right ovary
shows a hemorrhagic cyst with
thin, lacy, nonvascular strands
ſt and a retracted clot along
the periphery .
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