Diagnostic ultrasound ( PDFDrive )

CHAPTER 16 The Adnexa 571
A B C
D E F
G H I
FIG. 16.7 Hemorrhagic Cysts on TVS Scans: Spectrum of Appearances. (A) Acute hyperechoic hemorrhagic cyst. (B) Acute hemorrhagic
cyst mimicking a solid lesion. (C) Color Doppler ultrasound shows peripheral ring of vascularity (ring of ire), typical of a corpus luteum, but no
vascularity within the cyst. (D) Large cyst containing low-level internal echoes. (E) Reticular pattern of internal echoes and septations within cyst.
(F) Reticular pattern. (G)-(I) Variations in clot retraction. Concave margins in G are a sign of retracting clot. The blood products in I suggest a solid
mass. Lack of color Doppler ultrasound signal supports its benign nature. See also Video 16.2.
cul-de-sac helps conirm the diagnosis of a leaking or ruptured
hemorrhagic cyst. Rupture or leakage of a hemorrhagic cyst with
associated peritoneal irritation in the setting of a positive serum
B-hCG level may mimic a ruptured ectopic pregnancy, both
clinically and sonographically.
Functional cysts are the most common cause of ovarian
enlargement in young women. Because these cysts typically
resolve within one to two menstrual cycles, follow-up is usually
not required for small, simple cysts or typical hemorrhagic cysts
less than 5 cm in asymptomatic patients. However, follow-up
of larger cysts and those in symptomatic patients can be performed
following a normal menstrual cycle, usually in 6 weeks.
Because ultrasound may be unable to identify small mural
nodules within larger cysts, surgical intervention or further
characterization using MRI is generally recommended for cysts
greater than 7 cm. 28
Ovarian Remnant Syndrome
Infrequently, a cystic mass may be encountered in a patient who
has undergone bilateral oophorectomy due to a small amount
of residual ovarian tissue has been unintentionally let behind.
he surgery has usually been technically diicult because of
adhesions from endometriosis, PID, or tumor. 41 he residual
ovarian tissue can develop functional cysts and produce pelvic
pain and/or extrinsic compression of the distal ureter. Sonographically,
the cysts vary in size and can be both simple and hemorrhagic.
42,43 A thin rim of ovarian tissue is usually present in the
wall of the cyst. 43