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Adnexal masses
39
O
Adenxal masses
How to diagnose by US
Dr. Shimaa El-Gamal
- Anatomy
- Normal US
- Classification
#1
Title
Origin
Ovarian
Identify ovaries..
See if they are normal..
Are they separate from the mass?
"+ve sliding sign"!
Extra-ovarian
Wall?
Thick.. Thin.. Septa.. locules..
Contents?
Fluid.. Solid portions..
Doppler?
Other findings?
IOTA Simple Rules
Sensitivity and specificity of 92%-96%
About 15% of benign and 10% of malignant lesions will be misdiagnosed
1
Smooth, thin wall
Aechoic
No septa, no nodules
2
Diffuse thick wall
Size <3cm
Periphral flow
3
Smooth wall
Reticular pattern of internal echoes..
lace like pattern ..
Retracting clots..
No internal flow by
color doppler..
Jiggle like jello ^_^
4
Septations!!
like solid!!
Smooth wall with echogenic foci
Ground glass appearance
5
Dots and Dashes.. Hair strands
Bone, fat (Rokitansky nodule), pockets of sebum
Most common tumor to cause torsion ovary
sex cord
Classification of
ovarian neoplasms
Germ cell
Epithelial
Fibroma
Thecoma
Granulosa cell T
serous
mucinous
Endometroid
Brenner
Teratoma
Dysgerminoma
yolk sac Tumors
Choriocarcinoma
Embryonal cell Tumor
metastatic
Breast
Colon
Stomach
Appendix
endometrial
6
Irregural wall..
Solid parts.. Septae..
Doppler.. christmas tree..
7
solid mass.. well defined borders..
small lobulated..
younger age..
8
Round\ oval lobulated solid mass..
Heterogeneous "Stripey"..
Extra-ovarian masses
3Qs
+
Palpating
Probing
9
Tubular\ circular
Incomplete septae "Beads on a string"
Cogwheel apperance
10
11
Doppler