adnexa

Question 1

Answer 1

twisted vascular pedicle

image shows a twisted vascular pedicle extending into an enlarged and hypoechoic ovary. a twisted vascular pedicle is detected in about 88% of torsion cases. It is considered the most specific and definitive sign of torsion.

(board vitals)

Question 3

Answer 3

Question 4

appearance of teratomas on in and out of phase imaging

Answer 4

ovarian teratomas are characteristically bright on IP and OOP imaging. Aka: they have MACROscopic fat and NOT microscopic fat. And because they don’t have microscopic fat, they won’t drop signal of OOP.

Question 5

27 yoF with history of prior pelvic surgery

Answer 5

peritoneal inclusion cyst

occur almost exclusively in premenopausal women with active ovaries, pelvic adhesions, and impaired absorption of peritoneal fluid which leads to formatio of fluid filled cysts tha conform to the shape of the peritoneal cavity

Question 6

Next step?

Answer 6

nothing. this is a simple follicular cyst with a small peripheral follicle (cumulus oophorus)

Question 7

right ovarian mass shown in the image.

most common complication?

Answer 7

ovarian torsion

dermoid is shown in the picture

Question 8

most likely metastasis to the ovary?

Answer 8

gastric cancer (most common!)

shown in the CT images are “Krukenberg” tumors - characterized by mucin sectreting “signet ring” cells

other cancers that met to ovaries are breast, lung, and contralateral ovarian cancer

Question 9

Answer 9

brenner tumors

5th decade of life, small solid ovarian mass.

sometimes have internal calcs

Question 10

Answer 10

fibrothecoma

T2 dark = hypercellular

US shadowing

Question 11

Rotterdam criteria for PCOS

Answer 11

• Oligo- or anovulation
• Clinical or biochemical signs of hyperandrogenism
• Polycystic ovaries

Question 12

current imaging criteria defines the presence of polycystic ovaries

Answer 12

• One or both ovaries demonstrate ≥ 20 (This supersedes the initial Rotterdam criteria of >12 follicles.)
• One or both ovaries with volume > 10 mL

Question 13

Answer 13

ovarian torsion

The first image demonstrates a normal right ovary. The left ovary is enlarged, midline, does not enhance normally, and demonstrates regions of restricted diffusion, compatible with ovarian torsion. The patient underwent removal of the nonviable left ovary.

Question 14

most sensitive and specifics signs for ovarian torsion

Answer 14

sensitive sign: enlarged ovary (typically > 25mL)

Specific sign: whirpool sign (twisting of the pedicle)

Additional findings include:

• abnormal positioning (midline, anterior to uterus, in the cul-de-sac, contralateral adnexa),
• heterogeneous echotexture from hemorrhage and edema, associated cyst or neoplasm,
• uniformly peripherally displaced follicles (string of pearls sign),
• free fluid in the cul-de-sac,
• vascular compromise (lack of arterial and venous flow)