Transvaginal ultrasound assessment of the premenopausal ovarian mass

Abstract

The evaluation of the premenopausal ovarian mass with transvaginal ultrasound and color Doppler is reviewed.

Fig. 1

a A hemorrhagic corpus luteum is noted. Retracting clot is noted on the inner cyst wall. Circumferential blood flow is noted on color Doppler. Spontaneous resolution was noted at subsequent scan. b Another hemorrhagic cyst is noted. A much larger retracting clot is seen. The absence of color Doppler flow flow within the echogenic material is reassuring that this is not a solid neoplasm. Spontaneous resolution was noted

Fig. 2

This patient was experiencing pelvic pain 3 months status post myomectomy. An echogenic Fallopian tube is noted surrounded by a loculated fluid filled adhesion

Fig. 3

A complex mass cystic and solid is noted in this perimenopausal patient. Power Doppler revealed low-resistance vessels within this mass. A Stage III-C ovarian carcinoma was identified at exploratory laparatomy

Fig. 4

a A solid excrescence is noted on the inner cyst wall of this complex ovarian cyst. b Power Doppler examination of the mass shown in Fig. 4a revealed multiple intermediate resistance vessels. A Stage I–C epithelial ovarian cancer was found at laparatomy

Fig. 5

a A hemorrhagic corpus luteum is noted with circumferential flow. A few vessels appear to perforate and branch more centrally in the mass. b By angulation of the transducer multiple perforating vessels are demonstated centrally. This hemorrhagic corpus luteum regressed sponateously. To those unfamiliar with the vessel pattern of the corpus luteum this physiologic structure can be misinterpreted as a malignant neoplasm

Fig. 6

A typical endometrioma filled with low-level echoes is noted, Color flow reveals no flow centrally. Flow can be seen in the septa between loculations (not demonstated on this image). More normal ovarian tissue is noted at the upper right

Fig. 7

This mass was initially interpreted to be either a granulosa cell tumor or a corpus luteum. The mass did not resolve in 6 weeks time at the beginning of the cycle. A Stage IA granulosa cell tumor was found at surgical staging. The key was reimaging trhe patient

Fig. 8

A fairly typical cystic teratoma. This complex cystic mass contained hair, cartilage, and sebaceous material. These masses can be quite complex in appearance. Shadowing posterior the to echogenic regions is demonstrated about 90% of the time. (Not demonstrated this image) Color Doppler investigation was unremarkable. Color Doppler of cystic teratomas rarely reveals flow except at the junction between the mass wall and normal ovary. The echogenic material within the masses doen’t display flow. An exception is if struma–ovarri, carcinoid tumor, or malignant elements are noted. Moving material within these masses can cause false positive vascular flow on power Doppler. If there is a concern for malignant teratoma, AFP and HCG levels should be obtained

Fig. 9

A multiloculated cystadenoma is noted. No solid elements are noted. Flow may be seen in the cyst walls particularly with the mucinous varieties. If there is back to back crowding of the cysts or if the cysts are greater than 10 cm. borderline tumor or frank malignancy should be included in the differential even if no solid elements are identified

Fig. 10

This complex cyst with two areas of excrescence was found to be a adeno-fibroma at laparoscopy. Color Doppler doesn’t display flow within the excrescences. The differential diagnosis includes borderline malignancy. In our unpublished experience about 70% of cystic teratomas will reveal flow in the excrescences or solid elements of the tumor