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Mansour S, Hamed S, Kamal R. Spectrum of Ovarian Incidentalomas: Diagnosis and Management. Br J Radiol 2023; 96:20211325. [PMID: 35142537 PMCID: PMC9975533 DOI: 10.1259/bjr.20211325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 01/27/2023] Open
Abstract
Incidental ovarian lesions are asymptomatic lesions that are accidentally discovered during a CT or MRI examinations that involves the pelvic cavity or during a routine obstetric ultrasound study. Incidental ovarian masses are usually benign with a very low risk of malignancy yet underlying malignant pathology may be discovered during the diagnostic work-up of these lesions. Suspicion of malignancy is directly correlating with the increase in the patient's age, the increase in the size of the lesion, the presence of the solid components or thick septa and a high color scale of the ovarian mass. Following standard reporting and management protocols are essential to choose the proper work-up of these lesions to avoid unnecessary additional imaging and operative intervention. In this article, we will provide a review of the characteristic imaging features of some incidental and yet commonly encountered ovarian lesions. We will also summarize the recently published algorithms that are important for consistent reporting and standard management of these lesions.
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Affiliation(s)
| | - Soha Hamed
- Women’s Imaging Unit – Kasr El Ainy Hospital- Cairo University, Cairo, Egypt
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2
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Henrichsen TL, Maturen KE, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Friedman L, Learman LA, Patlas MN, Sadowski EA, Saphier C, Wasnik AP, Glanc P. ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain. J Am Coll Radiol 2021; 18:S119-S125. [PMID: 33958106 DOI: 10.1016/j.jacr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia, Vice Chair of Research, Department of Radiology, Medstar Georgetown University Hospital
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio, American Congress of Obstetricians and Gynecologists, Director, Center of Endometriosis, Co-director, Chronic Pelvic Pain, Associate Program Director, Fellowship in Minimally Invasive Gynecologic Surgery, Cleveland Clinic
| | - Lucas Friedman
- University of California Riverside, Riverside, California, American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, American Congress of Obstetricians and Gynecologists, Dean, Virginia Tech Carilion School of Medicine
| | - Michael N Patlas
- McMaster University, Hamilton, Ontario, Canada, Editor-in-Chief, Canadian Association of Radiologists Journal
| | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey, American Congress of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Gkrozou F, Tsonis O, Daniilidis A, Navrozoglou I, Paschopoulos M. Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520960649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals of Birmingham, Birmingham, UK
| | - Orestis Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Aggelos Daniilidis
- 2nd Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Navrozoglou
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
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Patel MD, Ascher SM, Horrow MM, Pickhardt PJ, Poder L, Goldman M, Berland LL, Pandharipande PV, Maturen KE. Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2020; 17:248-254. [DOI: 10.1016/j.jacr.2019.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022]
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Bullock RG, Smith A, Munroe DG, Ueland FR, Goodrich ST, Pappas TC, Fredericks TI, Bonato V. Combining A Second-Generation Multivariate Index Assay with Ovarian Imaging Improves the Preoperative Assessment of An Adnexal Mass. J Surg Oncol 2019. [DOI: 10.31487/j.jso.2019.03.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: To understand the relationship between imaging and the next generation multivariate index assay (MIA2G) in the preoperative assessment of an adnexal mass. Methods: Serum samples and imaging data from two previously published studies are reanalyzed using the MIA2G test. We calculated the clinical performance of MIA2G and discrete imaging features associated with malignant risk. Results: 878 women were eligible for this analysis, 48.3% post-menopausal and 51.7% pre-menopausal. The prevalence of having a malignant pathology was 18%. Ultrasound was the most frequently used imaging modality. The combination of MIA2G “or” ultrasound resulted in higher sensitivity than either test alone, 93.5% compared to 87.6% for MIA2G and 74.2% for ultrasound. The negative predictive value was high: 94.6% for ultrasound, 98.1% for MIA2G “or” ultrasound. MIA2G “and” ultrasound had higher specificity but lower sensitivity than MIA2G or ultrasound alone. Similar results were seen for CT scan when evaluated with MIA2G. Conclusion: MIA2G and pelvic imaging are complementary tests and interpreting them together can provide important information about the malignant risk of an ovarian tumor. For physicians making decisions about a referral to a specialist, the combination of MIA2G “or” ultrasound has the highest sensitivity in predicting ovarian malignancy.
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Non-visualization of the ovary on CT or ultrasound in the ED setting: utility of immediate follow-up imaging. Abdom Radiol (NY) 2018; 43:2467-2473. [PMID: 29230555 DOI: 10.1007/s00261-017-1438-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE In the setting of female patients in the ED receiving both a CT scan and ultrasound of the pelvis, we compared the studies to assess the diagnostic value of non-visualization of the ovary in predicting the absence of ovarian disease. METHODS A retrospective review of the electronic medical record identified adult female non-pregnant patients who received both a CT abdomen and pelvis and a transabdominal and transvaginal pelvic ultrasound within a 48-h period through the emergency department. The imaging studies were blindly reviewed to evaluate the ovaries on each CT and US independently. Ovaries were characterized as normal, non-visualized, or abnormal requiring follow-up. All cases of non-visualized ovaries were compared to the appearance on the corresponding exam for each patient, and assessed for agreement (normal or non-visualized) or disagreement (abnormal). Subsequently, the electronic medical record was used as a reference standard to assess the presence or absence of ovarian pathology over the subsequent ninety days. Statistical analysis was performed utilizing a McNemar test with a 95% confidence interval. RESULTS A total of 181 patients were included in the study (age range 18-75). Of these, 36 patients had non-visualization of one ovary (21 patients) or both ovaries (15 patients) on either study. On CT, 18 ovaries were non-visualized, with no cases of disagreement on ultrasound or subsequent short-term follow-up (NPV 100%). On ultrasound, 39 ovaries were non-visualized, with three of these adnexae appearing abnormal on CT (NPV 92%): one with an enlarged ovary and two with hydrosalpinx. No ovarian abnormalities were evident on chart follow-up. Significant correlation of agreement between normal and non-visualized pairs on CT and US was observed (p = 0.025, McNemar). There was a combined NPV of 94% regardless of modality for the absence of ovarian pathology in the case of non-visualization. The most common abnormal imaging findings associated with non-visualized ovaries were uterine fibroids and hemoperitoneum. CONCLUSION The absence of detection of the ovary on pelvic US or CT is highly predictive of the lack of ovarian abnormality on short-term follow-up, and does not typically require additional imaging to exclude ovarian disease.
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Gangadhar K, Mahajan A, Sable N, Bhargava P. Magnetic Resonance Imaging of Pelvic Masses: A Compartmental Approach. Semin Ultrasound CT MR 2016; 38:213-230. [PMID: 28705369 DOI: 10.1053/j.sult.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
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Affiliation(s)
- Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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El Maati AAA, Ibrahim EAG, Mokhtar FZ. A two-stage imaging protocol for evaluating women presenting with acute pelvic pain. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Katz DS, Khalid M, Coronel EE, Mazzie JP. Computed Tomography Imaging of the Acute Pelvis in Females. Can Assoc Radiol J 2013; 64:108-18. [DOI: 10.1016/j.carj.2012.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 12/30/2022] Open
Abstract
Sonography is the primary imaging modality for the evaluation of pelvic pain in female patients, especially if gynaecological pathology is suspected. However, computed tomography (CT) is frequently used in patients who present to emergency departments (and elsewhere) with otherwise nonspecific abdominal and pelvic pain and may be the first imaging modality to demonstrate an acute gynaecological abnormality. Computed tomography can also be used prospectively in selected patients to further evaluate findings initially identified on sonography, although to reduce radiation exposure, magnetic resonance imaging is being used more frequently in this situation. The purpose of this article is to discuss the spectrum of gynaecological findings of the acute female pelvis that may be identified on CT by the emergency radiologist and by the general radiologist, with a brief review of the imaging literature of each specific diagnosis.
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Affiliation(s)
- Douglas S. Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Maria Khalid
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Esther E. Coronel
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Joseph P. Mazzie
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
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Ochoa SR. Dolor pélvico en mujeres y el papel de la imágenes diagnósticas. MEDUNAB 2012. [DOI: 10.29375/01237047.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
El dolor pélvico es un motivo de consulta frecuente tanto en los servicios de consulta externa como de urgencias, e implica un reto diagnóstico para los médicos, especialmente en el caso de las mujeres, en quienes hay un amplio espectro de diagnósticos diferenciales debido a las estructuras contenidas que implican varios sistemas. Con este preámbulo vemos la necesidad de realizar una revisión de la literatura basada en la evidencia acerca del uso adecuado de las imágenes diagnósticas en estas patologías para obtener los mayores beneficios.
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Laing FC, Allison SJ. US of the Ovary and Adnexa: To Worry or Not to Worry? Radiographics 2012; 32:1621-39; discussion 1640-2. [DOI: 10.1148/rg.326125512] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging 2012; 3:265-75. [PMID: 22696088 PMCID: PMC3369119 DOI: 10.1007/s13244-012-0157-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 12/22/2022] Open
Abstract
Background The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status. Methods Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important. Results Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT. Conclusion MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients. Teaching points • Ultrasonography is easily accessible and can identify life-threatening gynaecological complications. • Tomography scanners and computed radiography are not routinely used but are important to recognise key features. • MRI is used for the characterisation of acute gynaecological complications. • Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.
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Affiliation(s)
- Oran Roche
- St Barts & The London NHS trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK,
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Benign and Suspicious Ovarian Masses-MR Imaging Criteria for Characterization: Pictorial Review. JOURNAL OF ONCOLOGY 2012; 2012:481806. [PMID: 22536238 PMCID: PMC3321462 DOI: 10.1155/2012/481806] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/15/2012] [Indexed: 01/13/2023]
Abstract
Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are currently used to evaluate ovarian tumors. US is the first-line imaging investigation for suspected adnexal masses. Color Doppler US helps the diagnosis identifying vascularized components within the mass. CT is commonly performed in preoperative evaluation of a suspected ovarian malignancy, but it exposes patients to radiation. When US findings are nondiagnostic or equivocal, MRI can be a valuable problem solving tool, useful to give also surgical planning information. MRI is well known to provide accurate information about hemorrhage, fat, and collagen. It is able to identify different types of tissue contained in pelvic masses, distinguishing benign from malignant ovarian tumors. The knowledge of clinical syndromes and MRI features of these conditions is crucial in establishing an accurate diagnosis and determining appropriate treatment. The purpose of this paper is to illustrate MRI findings in neoplastic and non-neoplastic ovarian masses, which were assessed into three groups: cystic, solid, and solid/cystic lesions. MRI criteria for the correct diagnosis and characteristics for differentiating benign from malignant conditions are shown in this paper.
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Transvaginal ultrasound in fertile patients with suspected appendicitis: an experience report of current practice. Emerg Med Int 2012; 2012:481797. [PMID: 22496979 PMCID: PMC3312202 DOI: 10.1155/2012/481797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 12/28/2011] [Accepted: 01/05/2012] [Indexed: 11/29/2022] Open
Abstract
Background. Transvaginal ultrasound (TVU) in female patients with acute right lower quadrant (RLQ) abdominal pain is time and infrastructure intensive and not always available. This study aims to evaluate the role of TVU in these patients. Methods. Retrospective analysis identified 224 female patients with RLQ pain and TVU. Results. TVU revealed an underlying pathology in 34 (15%) patients, necessitating a diagnostic laparoscopy in 12 patients. Six patients (2%) had a true gynaecological emergency. The remaining 23 patients did not require surgery. The other 190 patients with RLQ pain had a bland TVU; 127 (67%) were discharged, while 63 patients (33%) received a diagnostic laparoscopy. Conclusion. The incidence of true gynaecological emergencies requiring urgent surgical intervention is very low in our patient cohort. TVU is a helpful tool if performed by a physician who is well trained in TVU.
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Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review. Radiol Med 2012; 117:575-92. [DOI: 10.1007/s11547-011-0773-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/21/2011] [Indexed: 11/30/2022]
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Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and (18)F-FDG PET/CT. Nucl Med Mol Imaging 2011; 45:223-8. [PMID: 24900009 DOI: 10.1007/s13139-011-0089-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/02/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022] Open
Abstract
A 20-year-old woman, who presented with a several-week history of abdominal pain, was referred for magnetic resonance imaging (MRI) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after an ultrasound showed complex cystic masses arising from both ovaries. The MRI and (18)F-FDG PET/CT imaging characteristics of the ovarian masses were strongly suspicious for malignancy, and the masses were surgically removed. Histopathological evaluation revealed a bilateral tubo-ovarian abscess, with no evidence of malignancy. This case highlights a potentially serious pitfall in the evaluation of suspicious pelvic masses by (18)F-FDG PET/CT, whereby a complex bilateral tubo-ovarian abscess may mimic the PET/CT imaging characteristics of an ovarian or pelvic malignancy.
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Abstract
Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.
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Affiliation(s)
- R M Gore
- Department of Radiology, North Shore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL 60201, USA.
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Asch E, Levine D, Pedrosa I, Hecht JL, Kruskal J. Patterns of misinterpretation of adnexal masses on CT and MR in an academic radiology department. Acad Radiol 2009; 16:969-80. [PMID: 19380241 DOI: 10.1016/j.acra.2009.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 02/21/2009] [Accepted: 02/23/2009] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess potential quality assurance (QA) issues in the diagnosis and characterization of adnexal masses on pelvic computed tomographic (CT) and magnetic resonance (MR) imaging studies. MATERIALS AND METHODS Images from 128 women who had oophorectomies during a 16-month period with CT and/or MR studies within 5 years of surgery (145 CT scans from 103 women and 49 MR studies from 42 women, with 17 having both MR and CT studies) were reviewed by three radiologists who assigned QA scores of 0 (no QA issue), 1 (minor issue with minimal impact on clinical care), or 2 (major issue with potential impact on clinical care). The difficulty of diagnosis was assigned a score of 0 (very difficult diagnosis to make), 1 (difficult but possible to make the diagnosis), or 2 (diagnosis should be made). The incidence of adnexal QA issues was calculated using total CT and MR pelvic examinations performed on women during the interval. RESULTS Twenty-nine QA issues were identified in 28 women in 17 of 145 CT studies (11.7%) and 12 of 49 MR examinations (24.5%) in women having adnexal surgery (17 of 11,194 [0.15%] of female pelvic CT studies and 12 of 603 [2.0%] of female pelvic MR studies performed in the time interval). Issues included missed lesions, lesions misidentified as leiomyomas, fat described in the lesion but not seen histologically, postmenopausal status of patient not considered, ultrasound correlation not recommended, and confusion of right and left sides. CONCLUSION Errors in CT and MR studies regarding the diagnosis and characterization of adnexal masses in a highly enriched population of women undergoing adnexal surgery are common. Knowledge of the types of QA issues found in CT and MR studies of adnexal masses should aid in decreasing future errors.
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Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Fedele L. Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach. Gynecol Endocrinol 2009; 25:149-58. [PMID: 19347704 DOI: 10.1080/09513590802549858] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. In women several causes are recognised, although in a not negligible proportion of patients a definite diagnosis cannot be made. Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. Patients history is crucial and is generally of utmost importance for a correct diagnosis, being sometimes more indicative than several diagnostic investigations. The main contributing factors in women with CPP can still be identified by history and physical examination in most cases. Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process. Gaining women's trust and developing a strong patient-physician relationship is of utmost importance for the long-term outcome of care.
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Affiliation(s)
- Paolo Vercellini
- Clinica Ostetrica e Ginecologica I, University of Milan, Milan, Italy.
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Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23:667-78. [PMID: 19230781 DOI: 10.1016/j.bpobgyn.2009.01.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 01/05/2009] [Indexed: 01/09/2023]
Abstract
The optimum treatment for pelvic abscess would be an approach that is safe, efficacious, cost-effective, minimally invasive, and which affects the woman's fertility potential as little as possible. In women of reproductive age tubo-ovarian abscess is one of the most common types of pelvic abscess. Tubo-ovarian abscesses are classically treated with broad-spectrum antibiotics. Frequently this approach fails and surgical intervention becomes necessary in about 25% of all cases. Surgical procedures include laparotomy or laparoscopy with drainage of abscess, unilateral or bilateral salpingo-ophorectomy, and hysterectomy. However, surgery for tubo-ovarian abscess is often technically difficult and associated with complications. An alternative approach is the use of imaging-guided drainage of abscess in combination with antibiotics. Combined data from several studies indicate that ultrasound-guided transvaginal drainage with concomitant antibiotics is especially safe and efficacious. This chapter discusses the management of pelvic abscess with a special focus on transvaginal ultrasound-guided drainage of tubo-ovarian abscess.
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Affiliation(s)
- Seth Granberg
- Department of Obstetrics and Gynaecology, Akershus University Hospital, 1478 Lørenskog, Norway.
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Potter AW, Chandrasekhar CA. US and CT Evaluation of Acute Pelvic Pain of Gynecologic Origin in Nonpregnant Premenopausal Patients. Radiographics 2008; 28:1645-59. [DOI: 10.1148/rg.286085504] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Pelvic masses develop commonly in women of all ages and states of health. Despite the variety of masses that exist, general guidelines for diagnosis and management allow most masses to be treated in a generalist setting. This article is intended to guide non-obstetric and non-gynecologic physicians through diagnosis and treatment of nonmalignant pelvic masses. It includes information on physical examination, appropriate imaging techniques, laboratory tests, and variations in treatment for adolescents and pre- and postmenopausal women. It also addresses referral guidelines for suspected malignant masses.
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Affiliation(s)
- Spencer P Barney
- Department of Obstetrics and Gynecology, University of New Mexico Health Science Center, 2211 Lomas Blvd. NE, Albuquerque, NM 87131, USA.
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