Transabdominal color Doppler ultrasonography of the painful adolescent ovary.

Abstract

The objective of this study was to determine if color flow Doppler ultrasonography based on patterns of perfusion can aid in providing a specific diagnosis of ovarian masses associated with pelvic pain. Color flow Doppler images of 42 ovarian lesions in 42 adolescent girls (age range, 10 to 17 years) were analyzed prospectively. The color flow patterns were classified into three main categories: lesions with no vascularity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, seven simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ovarian torsions. A peripheral pattern of flow was observed in 29 of 34 (85%) cystic lesions, including 18 hemorrhagic and six simple cysts, three cystadenomas and two abscesses. Peripheral flow was also identified in four enlarged ovaries, two with inflammatory 0 varian lesions can be difficult to differentiate from each other on the basis of conventional gray-scale ultrasonography. 1 -6 Color Doppler sonography is an important supplement to disease and two with torsion. Internal flow was noted in five patients with enlarged ovaries due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovarian flow was identified in 90% of normal ovaries. Resistive indices, obtained in 33 abnormal ovaries, were higher in cystic lesions than in inflammatory lesions, although the values over~ lapped.Our findings showed that internal ovarian flow can be found in inflammatory processes and normal ovaries, but the absence of flow also is nonspecific and can be found in a variety of ovarian cystic lesions as well as in torsion. This overlap limits the usefulness of color Doppler ultrasonography for differentiating cystic ovarian lesions associated with pain in adolescent girls. KEY WORDS: Ovary; Cysts, ovarian; Cystadenoma; Abscess, ovarian.gray-scale technique because it allows evaluation of the pattern of blood flow within and around mass lesions. Recent studies in women have attempted to differentiate ovarian mass lesions on the basis of flow patterns on color Doppler ultrasonography?- 9 The lesions in these series differ significantly from those seen in childhood, which limits the usefulness of the data. The purpose of this study is to evaluate the usefulness of transabdominal color Doppler ultrasonography in adolescent girls for the diagnosis of painful ovarian masses based on the pattern of blood flow. PATIENTS AND METHODSThe gray~scale and color Doppler sonographic findings were analyzed prospectively in 42 girls with

Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis

“…The etiology for cyst rupture is not known, although it has been suggested that the increased vascularity of the ovary in the luteal phase may predispose to rupture of a corpus luteal cyst [6]. Although the sonographic appearance of the contained hemorrhage within an ovarian cyst has been well described [1][2][3][4][5], the imaging findings associated with cyst rupture and hemorrhage have not been similarly described in the literature. Consequently, patients with a ruptured ovarian cyst are frequently misdiagnosed with unrelated gynecologic, urologic, or gastrointestinal disorders both before and after imaging evaluation [6,7].…”

“…Indeed, the hemorrhagic ovarian cyst has been termed "the great imitator" [3]. Common sonographic patterns include a fluid-containing mass with a thick rim, internal strands and septations, internal echoes, a fluiddebris level, or a homogeneously hyperechoic mass [1][2][3][4][5].…”

“…Although the ultrasound findings of a "hemorrhagic ovarian cyst" have been well described, less attention has been given to the imaging findings produced when the bleeding is not contained in the ovary but rather extravasates into the pelvis and abdominal cavity [1][2][3][4][5]. Such a rupture and hemorrhage of an ovarian cyst is potentially catastrophic for the patient and is often misdiagnosed [6 -9].…”

Diagnostic and therapeutic capabilities of ultrasound in the management of pelvic pain

“…Doppler ultrasound does not play a decisive role in the diagnosis of adnexal torsion. Colour Doppler signals can be detected either peripherally or centrally in a substantial proportion of twisted adnexa [10,11]. Doppler findings probably mirror the vascular changes in the adnexa, persistent arterial flow being compatible with less complete stages of torsion.…”

Asynchronous bilateral ovarian torsion due to corpus luteum hemorrhage

“…Abdomino-pelvic ultrasound scan is the main investigation and Doppler acts as an adjunct to improve the diagnostic accuracy. 9 However, surgery is the definitive diagnostic modality. Laparotomy versus laparoscopy is the surgeon's discretion.…”