Ultrasound images: Gynecologic diagnoses (Part 1)

July 11, 2019

The first slideshow of our gynecologic ultrasound collection reviews commonly missed diagnoses and offers tips for recognizing them on ultrasound.

Deep infiltrating endometriosis

Transvaginal view of a loop of rectosigmoid, showing a nodular implant of endometriosis (calipers) in the muscularis of the bowel wall.

Pedunculated fibroid

Oblique transvaginal view of the right adnexa showing a pedunculated fibroid mimicking an adnexal mass. Gentle pushing with the transducer to try to separate the mass from the uterus helped to demonstrate the peduncle (arrow). This diagnosis is further confirmed by color Doppler mapping showing the connecting vessels.

Hemorrhagic cyst

Cystic mass containing a solid nodule.

Hemorrhagic cyst

Color Doppler flow seen peripherally only in the wall of the cyst and no blood flow in the solid area, consistent with a clot in a hemorrhagic corpus luteum cyst.

Ovarian cancer

Cystic mass containing an irregular solid nodule, similar to hemorrhagic cyst.

Ovarian cancer

Color Doppler flow in the center of the solid area consistent with a malignancy (pathology: endometrioid ovarian cancer).

Malignant granulosa cell tumor

Solid mass (calipers) with heterogeneous echo texture.

Malignant granulosa cell tumor

Abundant color Doppler flow throughout the mass, consistent with a malignancy.

Benign ovarian fibroma

Solid mass (calipers) with linear vertical showing (arrows), characteristic of a fibroma.

Benign ovarian fibroma

Solid mass (calipers) shown with scant blood flows seen on color Doppler.

Torsion

Transvaginal view of the left adnexa between the uterus and left ovary, showing a whirlpool sign (arrow) of the ovarian vasculature seen on color Doppler, a reliable sign of torsion.