Adnexal Pathology and Infertility

Question 1

parovarian cyst

Answer 1

• typically located in the broad ligament
• asymptomatic, pelvic pain, palpable pelvic mass
• round anechoic, smooth wall
• differential: cystadenoma, hydrosalpinx, ovarian cyst, meckel diverticulum, peritoneal cyst

Question 2

endometriosis

Answer 2

• ectopic location of functional endometrial tissue
• attaches to teh fallopian tubes, ovaries, colon, and bladder
• asymptomatic, dysmenorrhea, pelvic pain, irregular menses, dyspareunia, infertility
• difficult to visualize
• differential: adhesions or bowel interference

Question 3

ovarian induction therapy

Answer 3

• medication injected to stimulate follicular development
• stimulates pituitary gland to increase FSH
• estradiol levels are monitored for timing of intramuscular injection of hCG

Question 4

krukenberg tumors

Answer 4

• metastatic lesions, primary lesion from gastric carcinoma
• asymptomatic, abdominal pain, bloating
• bilateral adnexal or ovarian masses, oval, hypoechoic, posterior enhancement, ascites, bilateral
• differential: ovarian carcinoma, degenerating fibroid, tuboovarian abscess, cystic teratoma, endometrioma

Question 5

salpingitis

Answer 5

• pelvic infection
• pelvic pain, fever, dyspareunia, leukocytosis
• nodular, complex, posterior enhancement
• differential: bowel or endometrosis

Question 6

synechia

Answer 6

scarring caused by previous dilation and curettage or spontaneous abortion, demonstrated as hyperechoic band of echoes within the endo cavity

Question 7

pyosalpinx

Answer 7

• bacterial infection, diverticulitis, appendicitis
• asymptomatic, low-grade fever, pelvic fulliness
• complex, wall thickness > 5mm, irregular margins
• differential: bowel, ovarian neoplasm, iliac vessel, hydroureter

Question 8

infertility

Answer 8

• when comception does not occur with 1 year
• ovulatory disorders most common cause: PCOS, luteinizing unruptured follicle syndrome, luteal phase inadequacy
• fibroids 15 % of cases

Question 9

Meckel diverticulum

Answer 9

an anomalous sac protuding from the ileum caused by an incomplete closure of the yolk stalk

Question 10

pelvic inflammatory disease

Answer 10

• bacterial infection, diverticullitis, appendicitis
• abdominal pain, fever, vaginal dicharge, urinary frequency
• normal pelvic appearance, thick and hypervascular endo, complex tubular adnexal mass
• differential: normal pelvis, loops of bowel, endometriosis, ectopic

Question 11

gamete intrafollicular transfer

Answer 11

requires ovulation stimulation and retrieval of oocytes

the oocytes are mixed with sperm and then are transferred into the fallopian tubes

Question 12

during induction therapy

Answer 12

• monitor the size and number of follicles per ovary
• count and measure onlt the follicles greater than 1 cm
• optimal follicle size 1.5 to 2 cm
• correlate estrodiol level with size and number of follicles

Question 13

peritoneal inclusion cyst

Answer 13

• previous abdominal surgery, trauma, PID, endometriosis
• asymptomatic, lower abdominal pain, palpable mass
• septated fluid collection surrounding ovary, vascular flow can be demonstrated in septae
• differential: ascites, parovarian cyst, hydrosalpinx

Question 14

zygote intrafallopian transfer

Answer 14

zygote transferred into the fallopian tube

Question 15

endometrioma

Answer 15

• focal collection of ectopic endometrial tissue
• “chocolate csyt”
• pelvic pain, metromenorrhagia, dysmenorrhea, dysparenunia, pelvic mass, infertility
• hypoechoic, homogeneous adnexal mass, well defined, diffuse, avascular
• differential: hemorrhagic cyst, pedunculated fibroid, cystic teratoma

Question 16

in-vitro

Answer 16

• mature ova aspirated with ultrasound
• fertilization is accomplished in lab setting
• endo preparedto accept enbryo
• embryo are transferred into endo

Question 17

hdrosalpinx

Answer 17

• PID, endometriosis, postoperative adhesions
• asymptomatic, pelvic fullness, infertility
• anechoic tubular adnexal mass, thin wall margins, absence of peristalsis
• differential: bowel, dilated ureter, iliac vein, ovarian cyst, omental cyst

Question 18

ovarian hyperstimulation syndrome

Answer 18

• caused by high levels of hCG
• clinical findings: back pain, abdominal distention, nausea and vomiting, leg edema
• multicystic ovarian enlargement > 5cm in diameter

Question 19

fallopian tube carcinoma

Answer 19

• dsyplasia
• pelvic pain, abnormal bleeding, pelvic mass
• sausage-shaped complex adnexa mass, papillary projections
• differential: tuboovarian abscess or loops of bowel

Question 20

tuboovarian abscess

Answer 20

• pelvic infection, STD
• severe pelvic pain, fever, leukocytosis, nausea and vomiting
• complex, ill-defined wall margins
• differential: endometriosis, ectopic, hemorrhagic cyst