The adnexal incidentaloma: a practical approach to management

Abstract

There has been explosive growth in the utilization of cross-sectional imaging studies in the evaluation of patients with known or suspected abdominal and pelvic pathology. These imaging studies have led to a veritable epidemic of incidentally detected adnexal masses in both oncology and non-oncology patient populations that in the past remained undiscovered. In this commentary we provide some guidance and practical advice for further investigation and management of the adnexal incidentaloma.

Figure 1

Management of an adnexal incidentaloma discovered on an MDCT examination.

Figure 2

A right adnexal incidentaloma discovered during investigation of gastrointestinal symptoms using MDCT. (a) CT shows a 2.8-cm cystic right adnexal mass with a nodule in its anterior wall (arrow). (b) T2-weighted axial image shows a well-marginated, cystic, hyperintense, otherwise thin-walled right adnexal mass with a region of markedly reduced signal intensity anteriorly (arrow). (c) T1-weighted, fat suppressed, contrast-enhanced MR scan shows that this lesion has moderately high signal intensity except for the non-enhancing very low signal intensity region seen anteriorly (arrow) probably related to hemosiderin deposition. This is consistent with a benign lesion, such as an old endometrioma.

Figure 3

Right ovarian teratoma. The fat density of this lesion is sufficiently characteristic to establish the diagnosis and no further action is required (Fig. 1).