Diagnostic ultrasound ( PDFDrive )

CHAPTER 54 Pediatric Pelvic Sonography 1879
B
U
A
B
FIG. 54.13 Pelvic Varices Mimicking a Multiseptated Ovarian Cyst. Young woman with chronic liver disease and portal hypertension. (A)
Transverse sonogram of pelvis shows a multiseptated left adnexal mass. B, Bladder; U, uterus. (B) Transverse color Doppler sonography of pelvis
clearly demonstrates the vascular nature of the lesion. Pulsed Doppler showed venous waveforms (not shown).
FIG. 54.14 Polycystic Ovarian Disease: Stein-Leventhal Syndrome.
Sagittal sonogram of the left ovary in 21-year-old woman with
secondary amenorrhea, obesity, and hirsutism. The ovary is round and
contains multiple peripheral follicles (“string of pearls”), each of which
measures greater than 5 mm (and less than 9 mm).
accumulate in edema luid and promote luteinization, and level
of 17-ketosteroids may be increased.
Ovarian Neoplasms
Ovarian neoplasms account for 1% of all childhood tumors, and
10% to 30% of these are malignant. hese neoplasms may develop
at any age but most frequently occur at puberty. Abdominal pain
or a palpable abdominal or pelvic mass is the usual presenting
symptom. Symptoms may develop as a result of torsion or
hemorrhage into the tumor. Ovarian torsion is more common
in adolescents than in adults; however, ascites is less common
in girls. 44,45
Primary ovarian tumors can be classiied into three types of
cell origins: germ cells, epithelial cells, and stromal cells. In
FIG. 54.15 Ovarian Edema. Massive ovarian edema in a 13-year-old
girl with masculinization and intermittent pelvic and abdominal pain.
Sagittal sonographic image demonstrates a large, heterogeneous, primarily
hypoechoic mass posterior and separate from the uterus. This mass
contains marked sound through transmission and multiple tiny follicles
(arrows). Calipers, Endometrial stripe. (Courtesy of Marilyn Goske, MD.)
children, 60% of primary ovarian tumors are of germ cell origin,
in contrast to adults, in whom 90% are epithelial in origin. About
75% to 95% of germ cell tumors in childhood are benign teratomas.
However, there is a higher incidence of malignancy in
younger patients. In girls younger than 10 years, 84% of ovarian
germ cell tumors are malignant. he presence of ascites suggests
malignancy.