6. RANDOM OVARIAN PATH Flashcards
The most constant finding in ovarian torsion
Large ovary
Features of Ovarian Torsion
Unilateral enlarged ovary (> 4 cm)
Mass on the ovary
Peripheral cysts +/- fluid-debris level
Free fluid
Lack of arterial/venous flow
How does the ovary differ from the testicle?
OVary = dual blood supply
Just because you have flow, does NOT mean there isn’t a torsion.
Big ovary + pain =
Torsion
Hydrosalpinx
“string sign” - inclomplete septae
Thin (or thick in chronic states) elongated tubular structure in the pelvis.
Hydrosalpinx
“Cogwheel appearance”
normal longitudinal folds of a fallopian tube becoming thickened
this is suppose to help differentiate hydrosalpinx from an ovarian mass
“Waist sign”
“tubular mass with indentations of its opposing walls “
Causes of hydrosalpinx
skank, infidel, or free spirit = PID
Endometriosis, tubal cancer, post hysterectomy (without salpingectomy / oophorectomy), and tubal ligation.
Infection or inflammation of the upper female genital tract.
Pelvic Inflammator Disease
Pelvic Inflammator Disease
“Indefinite uterus”
This is a congenital remnant that arises from the Wolffian duct.
PAraovarian cyst
PAraovarian cyst
Round ovarian cyst that “do NOT distort the adjacent ovary”
OVarian vein thrombosis
a tubular structure with an enhancing wall and low-attenuation thrombus (arrow) in the expected location of the ovarian vein.
Ovarian Vein Thrombophlebitis are commonly seen in what population?
Postpartum women
Acute pelvic pain + fever + 10 days post delivery
Ovarian Vein Thrombophlebitis
Where is Ovarian Vein Thrombophlebitis usually located?
80% of the time it’s on the right.
Dreaded sequela of Ovarian Vein Thrombophlebitis
Pulmonary embolus
Tx - anticoagulation,
Peritoneal Inclusion Cyst occurs when?
Adhesions envelop an ovary
Peritoneal Inclusion Cyst
“Adhesions around an Ovary”
“Passive shape” that conforms to and is defined by surrounding structures.
A woman of reproductive age + Hx endometriosis + Pelvic surgery and PID
+ fluid filled mass = surrounds ovary + conforms to the shape of the pelvis
Peritoneal inclusion cyst
Most common form of Gestational Trophoblastic Disease
Hydatidiform Mole
Two subtypes of Hydatidiform Mole
- Complete (70%)
- Partial
This type of H-Mole involves the entire placenta.
Complete
Complete Hydatidiform Mole
“snowstorm” appearance in the first trimester
uterus to be filled with an echogenic, solid, highly vascular mass,
Complete Hydatidiform Mole
“bunch of grapes” appearance in the 2nd trimester
uterus to be filled with an echogenic, solid, highly vascular mass,
H-mole + portion of the placenta + jacked up fetus (triploid in karyotype)
= lethat to the fetus
Partial H-mole
fertilizationofanovumbytwo sperm (69XXY)
Partial H-mole
Parial Hydatidiform mole
What cysts are seen in molar pregnancies?
Theca lutein cysts
Most commonly bilateral in the 2nd trimetster
When can you see an invasive mole?
After treatment of H-mole (10%)
Invasive mole
focal myometrial masses, dilated vessels, and areas of hemorrhage and necrosis.
This is a very aggressive malignancy that forms only trophoblasts (no villous structure).
Choriocarcinoma
How does Choriocarcinoma spread?
locally
into myometrium + parametrium = spread hematogeneous to ANY site
Evacuation of molar pregnancy + Inc B-HCG in 8-10 weeks
Choriocarcinoma
Choriocarcinoma
a highly echogenic solid mass.
Tx = methotrexate
