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Age: 26

Sex: Female

Indication: Pelvic pain, negative pregnancy test

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Case #12


Findings

  • Rounded structure in the right ovary measuring 4 x 3.9 x 3.2 cm with lacelike internal echoes and layering echogenic material
  • Increased peripheral vascularity without internal vascularity
  • Moderate volume of heterogeneous fluid in the anatomic pelvis with complex fluid also demonstrated in Morison’s pouch in the right upper quadrant and small amount of free fluid in the left upper quadrant
  • Normal appearance of the left ovary
  • Arterial and venous waveforms are demonstrated in both ovaries on spectral Doppler analysis
  • Thickened endometrial echo complex, measuring up to 2.5 cm


Diagnosis

Ruptured ovarian cyst

Sample Report

Rounded structure in the right ovary measuring 4 x 3.9 x 3.2 cm with lacelike internal echoes, layering echogenic material, and no internal vascularity, likely representing a hemorrhagic cyst. Moderate volume hemoperitoneum likely related to cyst rupture. Recommend followup pelvic ultrasound in 6-12 weeks for further assessment.

Normal appearance of the left ovary. No evidence of ovarian torsion.

Thickened endometrial echo complex, measuring up to 2.5 cm. While this may be physiologic, recommend attention on followup imaging.


Discussion

  • Make sure you know the pregnancy test result when interpreting pelvic ultrasounds in female patients, as it may dramatically change your interpretation of the study
  • Note that the annotated images undermeasure the endometrial echo complex in this case – make sure to double check measurements provided by the sonographer
  • Please refer to the Incidental Findings Guidelines page for an overview of recommended management for incidental adnexal lesions



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