DDx of a pelvic mass

Question 1

What is important clinical information?

Answer 1

• Age
  
  • Last period
  • Regular periods
  • Hormonal therapy
  • Pelvic surgeries
    
    • What are the current complaints?

Question 2

What are the most common non-neoplastic adnexal lesions?

Answer 2

• Polycystic ovaries
• functional cysts
• endometriosis

Question 3

How would you describe the internal echotexture of an adnexal mass?

Answer 3

§ Cystic
§ Mixed 
§ Solid
§ Heterogeneous
§ Homogeneous
§ Isoechoic
§ Other distinct features

Question 4

How would define borders of an adnexal mass?

Answer 4

§ Well-defined
§ Poorly defined
§ Thin/thick-walled
§ Contour
§ Edge refraction

Question 5

How would you optimise colour Doppler to assess an adnexal mass?

Answer 5

• Decrease the scale to identify low flow
• Increase persistence and line density
• Decrease the colour box size to increase the sensitivity
• Establish the presence of flow in mass and peripheral circulation
• Describe the pattern/orientation of internal flow
• Recognise abnormal flow
• Information from the spectral waveform:
  ○ Establish the presence of arterial/venous flow
  ○ Measure the PSV and EDV
  ○ Calculate the PI/RI within the lesion