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Radiological Reasoning: Imaging Characterization of Bilateral Adnexal Masses

¹ Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.

View larger version (116K): [in a new window]   Fig. 1A —46-year-old woman who presented to emergency department with right-sided pelvic pain of gradually increasing intensity. Pelvic sonography was performed first.p Transverse sonogram from transabdominal examination shows two adnexal lesions (arrows) posterior to normal-appearing uterus.

View larger version (114K): [in a new window]   Fig. 1B —46-year-old woman who presented to emergency department with right-sided pelvic pain of gradually increasing intensity. Pelvic sonography was performed first.p Transvaginal sonograms reveal complex cystic mass on right (B) and a more solid-appearing hypoechoic mass on left (C). Neither ovary was seen separate from these adnexal lesions.

View larger version (115K): [in a new window]   Fig. 1C —46-year-old woman who presented to emergency department with right-sided pelvic pain of gradually increasing intensity. Pelvic sonography was performed first.p Transvaginal sonograms reveal complex cystic mass on right (B) and a more solid-appearing hypoechoic mass on left (C). Neither ovary was seen separate from these adnexal lesions.

View larger version (182K): [in a new window]   Fig. 2A —In same patient as in Figures 1A, 1B, and 1C, pelvic MRI was performed for further characterization of lesions. Axial T2-weighted image shows two lesions in right ovary, one large (solid white arrow) and the other small (black arrow), and single lesion in left ovary (dashed white arrow).

View larger version (171K): [in a new window]   Fig. 2B —In same patient as in Figures 1A, 1B, and 1C, pelvic MRI was performed for further characterization of lesions. Axial T1-weighted image shows that small right (black arrow) and left (dashed white arrow) ovarian lesions are homogeneously hyperintense, whereas large right ovarian lesion (solid white arrow) is hypointense.

View larger version (131K): [in a new window]   Fig. 2C —In same patient as in Figures 1A, 1B, and 1C, pelvic MRI was performed for further characterization of lesions. Sagittal T1-weighted image after administration of gadolinium shows no internal enhancement of large right ovarian lesion (arrow). Uterus (asterisk) and bladder (dot) are also seen.

View larger version (134K): [in a new window]   Fig. 2D —In same patient as in Figures 1A, 1B, and 1C, pelvic MRI was performed for further characterization of lesions. Axial T1-weighted images with fat saturation show that small right (black arrow, D) and left (dashed white arrow, D) ovarian lesions continue to be homogeneously hyperintense. Other tiny T1 hyperintense foci are seen in pelvis (arrowheads). Solid white arrow in D indicates large lesion in right ovary.

View larger version (113K): [in a new window]   Fig. 2E —In same patient as in Figures 1A, 1B, and 1C, pelvic MRI was performed for further characterization of lesions. Axial T1-weighted images with fat saturation show that small right (black arrow, D) and left (dashed white arrow, D) ovarian lesions continue to be homogeneously hyperintense. Other tiny T1 hyperintense foci are seen in pelvis (arrowheads). Solid white arrow in D indicates large lesion in right ovary.

View larger version (134K): [in a new window]   Fig. 3A —Follow-up pelvic sonography 9 weeks after initial examination of patient shown in Figures 1A, 1B, 1C, 2A, 2B, 2C, 2D, and 2E. Transvaginal sonogram of right ovary shows resolution of large complex cystic lesion. Smaller right ovarian lesion (arrow) is still present.

View larger version (129K): [in a new window]   Fig. 3B —Follow-up pelvic sonography 9 weeks after initial examination of patient shown in Figures 1A, 1B, 1C, 2A, 2B, 2C, 2D, and 2E. Transvaginal image of left ovary shows that left ovarian lesion is persistent and unchanged.

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