Patient History: A 22 years old woman who presented constant severe adnexal pain that was intermittently sharp and stabbing. Her last normal menstrual period had ended 3 weeks before.The patient had a similar episode 6 months ago which resolved spontaneously and diagnosed as musculoskeletal pain.
Images:
Image #1 Sagittal Rt Ovary
Images:
Image #1 Sagittal Rt Ovary
Image #2 Sag Rt Ovary-Color Flow
Image #3 Sag Rt Ovary- Doppler Duplex
Discussion: Based on the above 3 images, right ovary is enlarged and hypoechoic with multiple follicles along its periphery. Also, Color Doppler is shown reduced venous return from the ovary. It is result of stromal, edema, or internal hemorrhage or mass.
19 comments:
This case is not really interesting case that can bring your attention, but this pathology is very common in female. when thy have pelvic pain, you alway check color flow and doppler.
I have never seen this type of mass on ovaries at my clinical site. Thanks for the images and information.
My clinical instructors always emphasize for doing color and doppler if the patient has pelvic pain.
is anyone know the enlarged ovary is unilateral or bilateral?
The first picture is transabdominal and the second is transvaginal. Based on the symptoms and images, it appears to be a hemorrhagic cyst. It looks complex and may have some debris in it.
Leah
This case is interesting because the images would suggest a cyst. However from the discussion and patient history, ovarian torsion comes to mind. Specifically, this ovary measure greater than 4 cm; it is hypoechoic; there are prominent peripheral follicles; diminished Doppler flow; and acute unilateral pain of the right side. Those ultrasound findings/clinical symptoms would strongly suggest ovarian torsion. However, given that the patient had a similar incident 6 months prior that resolved spontaneously, this seems less likely.
do you know that hemorrhagic cysts are among the most common types of cysts. This ovarian cyst is also known as a blood cyst or hematocyst.
Irene said,
hmm. Interesting case. Have seen many hemorrhagic cyst bigger than this that they take up the entire space and pushes the uterus posteriorly.
Irene
yes, it is ovarian torsion,
but I never seen the case of ovarian torsion. is it bilateral or unilateral?
Evgeniya said,
Hemorrhagic cysts are a type of functional cyst, meaning that they occur during the course of the female menstruation process and are affected by the hormones.
Patients with ovarian torsion often present with sudden onset of unilateral lower abdominal pain like in our case.
Lack of ovarian blood flow on Doppler sonography seems to be a good predictor of ovarian torsion.
My impression was of ovarian torsion too, even though it was intermittent, because I think that can occur with ovarian torsion. The vessel will torse then untangle then torse again. It sounds like the ovarian vein in particular has been torsed, since the ovary is edematous and hypoechoic, suggesting there is a problem in venous flow.
Acute abdominal pain/discomfort can be a sign of ovarian torsion requiring immediate surgical intervention. The ovary partially or completely rotates around itself compromising lymphatic and venous drainage causing edema and loss of arterial and venous drainage.
I immeadiately thought that the ovary was torsed when you gave us the information that the blood flow to the ovary was decresed.
However, I also thought it might be a dermoid on the ovary. I guess not. Thanks for the images! Do you think the ovary became torsed because of the size of the pathology?
Hello Grace
Interesting case study.
According to the signs I think it is a hemorrhagic cyst with torsion of the ovary.
Interesting case, Grace!!!!!!
Initially I was thinking it was a large ovarian cyst since the patient has had intermittent pain. After looking at the pictures and seeing a large cystic structure in #1,what looked like a hypoechoic mass in image #2, and peripheral edema with reduced blood flow in image #3, I must agree with my fellow classmates...it appears to be ovarian torsion. An ovarian mass or corpus luteal cyst will increase chances of ovarian torsion. This finding coupled with sudden and intense unilateral pain and decreased ovarian blood flow makes me fairly certain that this is a case of ovarian torsion.
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