Diagnostic Ultrasound - Abdomen and Pelvis

Ovarian Hyperstimulation Syndrome
Diagnoses: Female Pelvis
TERMINOLOGY
• Ovarian hyperstimulation syndrome (OHSS)
• Clinical syndrome generally associated with ovulation
induction
IMAGING
• Bilaterally enlarged, cystic ovaries
○ Heterogeneous complex ovarian cysts with debris and
septa if hemorrhagic component present
○ Typical "spoke-wheel" appearance
• Ascites
○ Occasionally will find hemorrhagic pelvic fluid
• Pleural effusion
TOP DIFFERENTIAL DIAGNOSES
• Theca lutein cysts
○ Not associated with ascites, pleural effusions, or oliguria
• Hyperreactio luteinalis
○ More mild, indolent course within spectrum of OHSS
KEY FACTS
PATHOLOGY
• Exaggerated response to ovulation induction
• Relative hemoconcentration due to fluid leaking into
peritoneal/pleural spaces
CLINICAL ISSUES
• Typical clinical symptoms
○ Abdominal pain
○ Nausea/vomiting/diarrhea
○ Weight gain
○ Oliguria
• Should be self-limiting as long as supportive care started
early in process
DIAGNOSTIC CHECKLIST
• Avoid aggressive transvaginal imaging as ovaries can be
friable
• Correlate imaging appearance of ovaries with clinical
history for diagnosis
(Left) Endovaginal transverse
sonographic view of the pelvis
shows typical ovarian
hyperstimulation syndrome
(OHSS), in which decidual
reaction is present in the
uterus , with anechoic free
fluid st and enlarged ovaries
containing multiple cysts ſt
(right ovary). (Right)
Transabdominal US of the
right upper quadrant shows
ascites ſt and a pleural
effusion in this patient
with early OHSS.
(Left) Transvaginal US shows a
markedly enlarged ovary
measuring up to 8 cm
(calipers) in diameter with
multiple follicles and ascites
in a patient with OHSS.
(Right) Spectral Doppler in the
same patient shows normal
low-resistance arterial flow in
the ovary . Color Doppler
and spectral Doppler should
be used to evaluate the
ovarian parenchyma in
patients with OHSS to
document good blood flow in
patients presenting with pain
due to the risk of
superimposed adnexal torsion.
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