Diagnostic ultrasound ( PDFDrive )

592 PART II Abdominal and Pelvic Sonography
Gastrointestinal Tract Masses
he most frequent pelvic pseudomasses are fecal material in the
rectum simulating a complex mass in the cul-de-sac and a luidilled
rectosigmoid colon presenting as a cystic adnexal mass.
TVS can usually distinguish the pseudomass from a true mass,
but when it cannot, a repeat examination or MRI may be necessary.
Bowel neoplasms, especially those involving the rectosigmoid,
cecum, and ileum, may simulate an adnexal mass. hese
tumors frequently show the characteristic target sign of a
gastrointestinal mass, consisting of a central echogenic focus
caused by air within the lumen, surrounded by a thickened
hypoechoic wall. 212 Abscesses related to inlammatory disease
of the gastrointestinal tract may also present as an adnexal mass.
On the right side, this is most frequently caused by appendicitis
or Crohn disease, whereas abscesses on the let side are usually
caused by diverticular disease and are seen in an older age group.
Urinary Tract Masses
Patients with a pelvic kidney may present with a clinically palpable
mass. his is readily recognized sonographically by the typical
reniform appearance and the absence of a kidney in the normal
location. Occasionally, a greatly distended bladder may be
mistaken for an ovarian cyst. When a cystic pelvic mass is
identiied, it is imperative that the bladder be seen separately
from the mass. If the origin of the cystic mass continues to be
in question, having the patient void or draining the bladder with
a Foley catheter can ensure a decompressed bladder. Bladder
diverticula may also simulate a cystic adnexal mass. he diagnosis
can be conirmed by demonstrating communication with the
bladder and a changing appearance ater voiding. Dilated distal
ureters may simulate adnexal cysts on transverse scans; however,
sagittal scans show their tubular appearance and continuity with
the bladder.
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