Diagnostic ultrasound ( PDFDrive )

CHAPTER
16
The Adnexa
Rochelle Filker Andreotti and Lori A. Deitte
SUMMARY OF KEY POINTS
• The normal sonographic appearance of the ovaries
changes with the menstrual cycle because of the inluence
of gonadotropins. These changes cease to occur as late
menopause is reached and developing follicles are no
longer present.
• Nonneoplastic lesions of the ovary and adnexa are usually
simple cysts or cysts that contain blood products and are
often physiologic. These include hemorrhagic physiologic
cysts and endometriomas that can often be differentiated
based on the sonographic appearance of the type of blood
products. Other common nonneoplastic cysts include
paraovarian cysts, hydrosalpinges, and peritoneal inclusion
cysts.
• Ovarian torsion, a condition caused by rotation of the
ovarian pedicle on its axis, is a surgical emergency and
sonography is valuable in making the diagnosis.
• Morphologic and Doppler sonographic indings in
neoplasms can be highly accurate in differentiating benign
from malignant masses.
CHAPTER OUTLINE
NORMAL ANATOMY
Technique
Normal Sonographic Appearance of the
Ovary and Fallopian Tube
Changes During the Menstrual Cycle
Postmenopausal Ovary
Postmenopausal Cysts
NONNEOPLASTIC LESIONS
Functional Cysts
Ovarian Remnant Syndrome
Pregnancy-Associated Ovarian Lesions
Surface Epithelial Inclusion Cysts
Paraovarian and Paratubal Cysts
Peritoneal Inclusion Cysts
Polycystic Ovarian Syndrome
Endometriosis
Adnexal Torsion
NEOPLASMS
Ovarian Cancer
Surface Epithelial–Stromal Tumors
Serous Cystadenoma and
Cystadenocarcinoma
Mucinous Cystadenoma and
Cystadenocarcinoma
Borderline (Low Malignant Potential)
Tumors
Endometrioid Tumor
Clear Cell Tumor
Transitional Cell Tumor
Germ Cell Tumors
Cystic Teratoma
Dysgerminoma
Yolk Sac Tumor
Sex Cord–Stromal Tumors
Granulosa Cell Tumor
Sertoli-Leydig Cell Tumor
Thecoma and Fibroma
Metastatic Tumors
FALLOPIAN TUBE
Pelvic Inlammatory Disease
Tubal Torsion
Fallopian Tube Carcinoma
VASCULAR ABNORMALITIES IN THE
ADNEXA
Ovarian Vein Thrombosis or
Thrombophlebitis
Pelvic Congestion Syndrome
SONOGRAPHIC EVALUATION OF AN
ADNEXAL MASS IN ADULT
WOMEN
NONGYNECOLOGIC ADNEXAL
MASSES
Postoperative Pelvic Masses
Gastrointestinal Tract Masses
Urinary Tract Masses
Sonography is the modality of choice for imaging the pelvis,
including the adnexa, because it is noninvasive, radiation
free, cost efective, and widely available. Sonography allows for
accurate delineation of uterine and ovarian architecture and
assessment of vascular low. Transvaginal sonography (TVS)
is a fundamental part of pelvic ultrasound examinations because
of the use of higher frequency transducers (up to 10 MHz) and
the vaginal probe’s proximity to the uterus and adnexa. However,
transabdominal sonography (TAS) continues to be the mainstay
when structures are high in the pelvis, out of the ield of view
of the TVS probe; in pediatric patients; and in those who have
diiculty tolerating TVS. Color and spectral Doppler sonography
allow for assessment of normal and pathologic blood low. Doppler
ultrasound can also distinguish vascular structures from nonvascular
structures, such as dilated fallopian tubes or luid-illed
bowel loops.
NORMAL ANATOMY
Bilaterally, the broad and round ligaments, fallopian tubes, ovaries
and their associated vascularity extend from lateral uterine corpus
forming the pelvic adnexa. Laterally, the peritoneal relection
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