Ultrasound signs of ovarian pathology

Ovarian pathology

Normal ovaries are usually less echogenic than the myometrium and less uniform due to small follicles. Visualization of the ovaries in postmenopausal women, especially after age 50, can be difficult.

Ovarian cysts

The follicle is a physiological "cyst" of the ovary, which usually disappears in the second phase of the menstrual cycle. If the follicle does not rupture in the middle of the cycle, a follicular cyst develops, which is one of the most common ovarian cysts; the cyst can have a diameter of over 3 cm. Immediately after the rupture of the cyst, fluid can be detected in the retrouterine space.

Retention cysts have smooth contours, are anechoic, have good distal pseudoenhancement and are always benign. Parovarian cysts develop from rudimentary embryonic structures of the small pelvis.

During ultrasound examination, ovarian cysts may be anechoic, almost solid, or have mixed echogenicity due to hemorrhage into the cyst cavity, septa, and parietal growths. Multi-chamber cysts have a pronounced enhancement of the posterior wall, variable internal echostructure, and are most often malignant.

Small or medium-sized ovarian cysts located behind the uterus or bladder may not be visualized, especially when the bladder is not full. Large ovarian cysts are often located above the fundus of the uterus when the bladder is full and may cause bladder displacement. Large cysts may be mistaken for the bladder and should be identified.

Dermoid cyst (cystic teratoma) is visualized as a solid or mixed echogenicity structure with areas of calcification of the bones or teeth contained in the cyst, which produce an acoustic shadow. If there is any doubt, it is necessary to perform X-ray of the pelvic organs.

Echinococcal (parasitic) pelvic cyst

Parasitic cysts, often multiple, can be of different sizes and are located almost anywhere; some cysts have partitions. If echinococcosis is suspected, it is necessary to conduct an ultrasound examination of the liver and chest X-ray to exclude the presence of such cysts.

Solid ovarian masses

Solid lesions are rare and often necrotic or hemorrhagic by the time they are detected on sonography. Solid ovarian lesions may be confused with pedunculated uterine fibroids, and a careful search for a uterine connection is necessary.

Cystic formations in the pelvis in postmenopausal women often turn out to be malignant.

Inflammatory diseases of the pelvic organs

In inflammatory diseases of the pelvic organs, adhesions, tissue displacement, displacement of the uterus or ovaries, fixation and changes in the echogenicity of parametric tissues may occur. However, the echographic data may be normal, and the clinical examination may be more accurate. Tuberculosis of the pelvic organs cannot be differentiated from other inflammatory processes in the pelvis according to echographic data. The detected formation may be an endometrioma, abscess or ectopic pregnancy. An accurate diagnosis may be quite difficult.

Fluid in the pelvis (ascites)

When detecting fluid in the pelvis, one can assume the presence of ascites, blood, pus, or the contents of a ruptured cyst. To detect fluid, it is necessary to conduct an examination in various planes.

The fluid may be completely anechoic or contain internal echo structures due to suspension. Fluid accumulations may also be detected in the vagina and uterine cavity.

There are many reasons for the appearance of formations in the pelvis. Echography cannot always differentiate these formations.

Abscesses in the pelvis

Any localized, complex echostructure pelvic formation may be inflammatory, but pyogenic and tuberculous inflammation look the same echographically. It is often impossible to accurately indicate the localization and etiology of the formation of inflammatory genesis: therefore, clinical examination is very important.