The second slideshow of our gynecologic ultrasound collection reviews more commonly missed diagnoses and offers tips for recognizing them on ultrasound.
For more information on gynecologic ultraound:Â Gynecologic ultrasound primer: How not to miss the diagnosisFor Part 1: Ultrasound images: Gynecologic diagnoses (Part 1)
3D reconstructed coronal view of the uterus showing a normal triangular endometrial cavity including the cervix
Complete uterine septum (magnified)
Magnified view of the 3D reconstructed coronal view of the uterus showing a septum completely dividing the endometrial cavity into two horns but with an intact serosal outer surface.
Embedded IUD (longitudinal)
The longitudinal view of the uterus shows the IUD as an echogenic structure in the center of the uterus.
Embedded IUD (coronal 2D view)
The coronal 2D view of the uterus shows the IUD as echogenic structure in the center of the uterus.
Embedded IUD (3D reconstructed coronal view)
The 3D reconstructed coronal view shows that the right arm of the IUD (arrow) is poking out of the cavity and embedded in the right myometrium. This could not be appreciated with the longitudinal or coronal 2D views.
3D reconstructed view of a hydrosalpinx seen using the inverse mode where the entire fluid-filled tube is opaque showing the entire tube within the volume regardless of plane of selection.
Tubular cystic lesion in the right adnexa thought to represent a hydrosalpinx on an ultrasound done elsewhere. The uterus and ovaries were normal. This was an appendiceal mucocele.
An ill-defined mass in the right adnexa, containing pockets of air (arrows). This patient presented with acute right lower quadrant pain and was diagnosed with an appendiceal abscess
Diverticulitis resulting in a tuboovarian abscess
The patient presented with acute left lower quadrant pain. The adnexal mass is solid (large arrows) but hypoechoic. There is a very echogenic rim on the side closest to the transducer (small arrow) that represents the inflamed pericolic fat often associated with bowel lesions.
This patient was sent for a second opinion because this tubular lesion was thought to be a hydrosalpinx. Upon observation, the lesion seemed to undergo peristalsis vigorously and the patient was discovered to have a congenital megaureter on prior history.
This cystic lesion was seen incidentally in the posterior aspect of the pelvis. The uterus and ovaries were normal. Note the lack of blood flow inside the lesion. There was a similar mass on the opposite side, consistent with Tarlov perineural cysts. Thes are often mistaken for adnexal masses.