Ovary

General

  • If a pelvic ass is T2 hypo, it is typically fibrous, the most common of which is a fibroid

O-RADS

Endometrioma

  • T2 dark

  • T1 bright

  • T1FS-bright

  • Has internal T1 hyperintensity from old blood

  • On US

    • No color on doppler

Kruckenberg tumor

  • Metatstaic adenocarcinoma lesion to the ovary

  • Large and usually bilateral

  • Gastric cancer is most common primary

Dermoid/Teratoma

  • T2 bright

  • T1 dark

  • T1FS dark

  • On Us

    • Tip of the iceberg (bottom)

      • Broad area of deep hypoechogenicity with iso or hyperechogenic area superficially

    • Fluid-fluid level

      • High echogenic substance is in anti-dependent portion and fluid is on bottom

      • Chemical shift artifact at border of fat and fluid in the frequency encoding direction

    • Dot-dash sign

    • Fat ball sign (top)

    • No color on doppler

  • Rokitansky nodule = dermoid plug

    • If enhances, question malignant transformation

  • Risk of rupture <5%

  • Risk of torsion = 15%

  • Risk of malignant transformation = 1%

Peritoneal Inclusion Cyst

  • Basically cyst in the pelvis

  • Very commonly arises next to/surrounds the ovary

  • Seen in women of reproductive age

  • May have septation

  • Not your typically well circumscribed cyst, its basically if there is inflammation and scarring or whatever and it walls off a fluid collection that is sterile (not an abscess)

  • Looks like a non circular cyst around ovary usually

Serous Cystadenoma

  • Unilocular

  • Thin walled

  • Simple fluid

  • On US have papillary projections

  • Basically what you think of when you think of a simple cyst

  • Note - may get bigger and likely persists over time, a follicular cyst will go away after 2-3 menstrual cycles

Granulosa Cell tumor

  • Solid and Cystic mass

  • Unilateral

  • Most common ovarian neoplasm

  • Typically post-menopausal women

  • Estrogen secreting tumor

    • Look for endometrial hyperplasia/endometrial thickening

Brenner Tumor

  • Mixed solid and cystic mass

  • Benign

  • Low T2 signal secondary to high fibrous content

References:

Cystic Adnexal Masses

Hemorrhagic Cyst

  • T2 bright

  • T1 dark

  • T1-FS bright

  • On US

    • Fluid-fluid level

      • High echogenic substance is in dependent portion and fluid is on top

    • Fibrin threads

      • Linear increased echogenic lines

      • Has a cobweb appearance - US below

    • Retractable clot (left thick arrow in US below)

    • No color on doppler

Mature Teratoma

  • Large clusters of fat

  • Usually more well defined

  • Large tooth-like clusters of calcifications

Ovarian Fibroma/Fibrothecoma

  • T1 hypo

  • T2 very hypo

  • Mild diffuse enhancement

  • Note: endometriomas will have internal T1 hyper signal from old blood

Struma Ovari

  • Multiloculated cystic lesion with strongly enhancing solid nodule

Simple Cyst

  • T2 bright

  • T1 dark

  • T1-FS dark

  • On Us

    • No color on doppler

Hydatid Cysts of Morgagni (Paratubal cyst)

  • Simple cyst near end of the fallopian tube in close proximity to the fimbriae

  • Asymptomatic

  • Honestly just looks like a random pelvic cyst, just not next to the ovary itself I guess, closer to the tube

Mucinous Cystadenoma

  • Multiloculated

  • Thin walled with septa

  • Simple and/or complex fluid

Non Cystic Ovarian Masses

Dysgerminoma

  • Typically a purely solid mass

    • May have hemorrhage and necrosis making it look heterogenous

Lymphoma

  • Burkitt lymphoma

    • Unilateral or bilateral mixed solid and cystic lesions

    • Look for concurrent ileal disease

Immature Teratoma

  • Scattered small areas of fat interspersed between soft tissue mass

  • Typically larger and less defined vs mature teratoma

  • Irregular and amorphic calcifications

Hyperreactio Luteinalis

  • Very similar to ovarian hyperstimulation syndrome

  • Bilateral enlarged multicystic ovaries

  • WILL HAVE ELEVATD HCG

  • Associated with molar pregnancy

  • Benign and will resolve with delivery of normal pregnancy or removal of the molar pregnancy in cases of molar pregnancy

Fallopian Tube

These are thickened longitudinal folds, a normal structure in the fallopian tube. When these are seen it is pathognomonic that you are in the fallopian tube and not elsewhere. The images below show hydrosalpyx because tube is also dilated with fluid.

Meigs Syndrome

  • Triad of

    • Ascites

    • Pleural Effusion

    • Benign ovarian mass

      • 8-& are fibromas (fibrothecoma)

Syndromes

Ovarian hyperstimulation syndrome

  • Range of mild to severe

    • Severe will have ascites and hemodynamic instability, renal failure, ARDS

  • Bilateral ovary enlargement

  • Associated with IVF

Massive Ovarian Edema

  • Unilateral

  • Makes it look like the ovary is solid without focal mass

  • Thought to be due to chronic torsion

  • Peripheralization of the follicles with normal blood flow

  • Enlarged ovary

  • Ovarian fibromatosis basically presents the same but due to fibrous tissue rather than edema