Diagnostic ultrasound ( PDFDrive )

1878 PART V Pediatric Sonography
A
Cyst
B
2
1
B
C
D
Transverse LT Ovary
FIG. 54.12 Hemorrhagic Ovarian Cysts in Four Teenagers With Left Pelvic Pain: Spectrum of Appearances. (A) Transverse view of the
pelvis reveals a large, round cyst within the ovary (arrows, ovary) that contains a luid-debris level representing a hemorrhagic cyst. (B) Sagittal
transabdominal sonography (TAS) shows enlargement of the left ovary with a rim of ovary surrounding a cyst that contains multiple, echogenic,
streaky densities. B, Bladder. (C) Transvaginal ultrasound (TVS) conirms the presence of surrounding ovarian tissue and the heterogeneous
appearance of the contained luid. (D) and (E) TVS images of left ovary demonstrate jagged material within the clearly deined cyst.
E
Transverse LT Ovary
of endometrial carcinoma from long-term unopposed
estrogen. 37,41
Massive Ovarian Edema
Massive edema of the ovary manifests with marked enlargement
of the afected ovary caused by accumulation of edema luid in
the stroma, separating normal follicular structures (Fig. 54.15).
It is thought to result from partial or intermittent torsion that
interferes with venous and lymphatic drainage. It afects patients
during their second to third decades of life and causes acute
abdominal pain, palpable adnexal mass, menstrual disturbances
at times, masculinization, and Meigs syndrome. Two-thirds of
patients have right-sided ovarian edema, thought to be related
to high pressure in the right ovarian vein caused by direct drainage
into the inferior vena cava (IVC) or increased pressure secondary
to uterine dextroposition. he ovaries may be massively enlarged,
with diameter up to 35 cm. Grossly, the external surface is sot
and pearly white and appears similar to ibromatosis, a condition
likely to occur in young women (up to 25 years of age) in which
primary proliferation of the ovarian stroma may result in torsion
and ultimately edema. he sonographic features of ovarian edema
include a solid, hypoechoic mass, enhanced through transmission,
and cystic follicles within the lesion. 42,43 he masculinization is
thought to be caused by stromal luteinization that results from
mechanical stretching of the stromal cells by the edema luid.
In addition, human chorionic gonadotropin–like substance may