Tammy T. ChangGillian Lieberman, MD
Radiologic Evaluation of Complex Adnexal Mass
Tammy T. Chang, Harvard Medical School Year IIIGillian Lieberman, MD
August 2001
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AgendaTo discuss:
•Anatomy of Female Pelvis
• Radiologic Modalities Used to Evaluate the Female Pelvis
• Differential Diagnosis of Complex Mass in the Female Pelvis
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Female Pelvic Anatomy
http://www.bartley.com/107/illus1165.html
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Hysterosalpingogram
http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html
Fallopian Tube
Uterine Cavity
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Ms. L, 31-years-old, presents with
right lower quadrant pain
Our Patient:
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Radiological Modalitiesfor Evaluation of Female PelvisUltrasound
TransabdominalTransvaginal
Magnetic ResonanceImaging
ComputedTomography
Noionizing radiation and
i.v. contrast
Noionizing radiation and
i.v. contrast
Ionizing radiationand i.v. contrast
Initial evaluation Surgical evaluation Staging for ovariancancer
Differentiates cysticfrom solid lesions
Best typifiesNature of lesion
Evaluates sizableovarian masses
Swartz, L.B. and Seiger, D.B. 1992. J Repro Med 37:63-71
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Our Patient’s pelvic ultrasound
Courtesy of Dr. Chad Brecher, M.D. Complex Mass
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Complex Mass
Normal Ovary
Courtesy of Dr. Chad Brecher, M.D.
Our Patient’s complex adnexal mass
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Differential Diagnosis forComplex Adnexal Mass
BenignCystadenomaHemorrhagic cystEndometriomaTeratoma
MalignantOvarian Carcinoma
EpithelialGerm cellStromal
OtherEctopic pregnancyAbscessHematoma
Uterin OriginSubserosal uterin fibroid
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Courtesy of Dr. Chad Brecher, M.D.
AscitesHydroureter
Our Patient: Axial Abdominal CT
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Pelvic Mass
Courtesy of Dr. Chad Brecher, M.D.
Our Patient: Pelvic CT
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Mass
Uterus
BladderCourtesy of Dr. Chad Brecher, M.D.
Our Patient: Coronal CT
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Let’s Review the characteristic appearance of some other adnexal masses
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Patient 2: Ultrasound of Simple Cyst
BIDMC PACS
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Patient 3: T1-weighted MR
Mass
Uterus
Bladder
http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html
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Patient 3: Fat-suppression MR
Endometrioma Teratoma
http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html
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Conclusion
• US and MR - major modalities for evaluating female pelvisCT - role in staging ovarian cancer
• Current imaging are non-specific in distinguishing between benign and malignant complex masses
• Some techniques allow definitive diagnosis of characteristic masses e.g. fat-suppressing MR identifies teratomas from hemorrhagic cysts or endometriomas
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ReferencePublications• Kawamoto, S., Urban, B.A., Fishman, E.K. CT of epithelial ovarian tumors. Radiographics 1999; 19:S85-S102.• Occhipiniti, K.A., Frankel, S.D., Hricak, H. The ovary computed tomography and magnetic resonance imaging. Radiologic Clinics of North America 1993; 31:1115-1132.• Schwartz, L.B and Seifer, D.B. Diagnostic Imaging of Adnexal Masses A Review. J Reproductive Medicine 1992; 37:63-71.• Urban, B.A. and Fishman, E.K. Helical (spiral) CT of the female pelvis. Radiologic Clinics of North America 1995; 33:933-948.• Woodward, P.J. and Gilfeather M. Magnetic resonance imaging of the female pelvis. Seminars in US, CT, and MRI 1998; 19:90-103.
Web Resources• Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febifer, 1918; Bartleby.com, 2000. www.bartleby.com/107/illus1166.html. [9/14/01]• http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html• http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html
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Acknowledgements
Chad Brecher, M.D.Larry BarbarasCara Lyn D’amourPamela Lepkowski
Gillian Lieberman, M.D.