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Sonography of Obstetric and Gynecologic Emergencies

Part II, Gynecologic Emergencies

¹ Department of Radiology, The University of Washington Medical Center, 1959 N.E. Pacific St., Seattle, WA 98195-7115.
² Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., TC2910Q, Ann Arbor, MI 48109-0326.
³ Department of Radiology, University of Wisconsin Hospital, E3/311, CSC 600 Highland Ave., Madison, WI 53792-3252.

View larger version (141K): [in a new window]   Fig. 1A. —24-year-old woman with pelvic inflammatory disease and tuboovarian complex. Sagittal endovaginal sonogram reveals complex free fluid (FF). U = uterus.

View larger version (123K): [in a new window]   Fig. 1B. —24-year-old woman with pelvic inflammatory disease and tuboovarian complex. Coronal image of left adnexa reveals dilated fallopian tube (T) with echogenic fluid. Findings are consistent with those of pyosalpinx.

View larger version (164K): [in a new window]   Fig. 1C. —24-year-old woman with pelvic inflammatory disease and tuboovarian complex. Black-and-white photograph of color Doppler image reveals enlarged hyperemic ovary, a finding consistent with oophoritis.

View larger version (138K): [in a new window]   Fig. 2A. —15-year-old girl with pelvic pain, fever, and bilateral tuboovarian abscesses. Endovaginal sonogram reveals bilateral complex cystic lesions replacing ovaries. Surgery revealed bilateral tuboovarian abscesses. LT = right ovarian mass, RT = left ovarian mass, UT = uterus.

View larger version (155K): [in a new window]   Fig. 2B. —15-year-old girl with pelvic pain, fever, and bilateral tuboovarian abscesses. Transverse endovaginal sonogram of right cystic mass.

View larger version (142K): [in a new window]   Fig. 2C. —15-year-old girl with pelvic pain, fever, and bilateral tuboovarian abscesses. Transverse endovaginal sonogram of left cystic mass. Although this is a surgically proven case, tuboovarian abscesses typically appear as complex multiloculated masses with variable septations, irregular margins, and scattered internal echoes.

View larger version (114K): [in a new window]   Fig. 3. —30-year-old woman with torsion of chronic hydrosalpinx. Patient was being treated for pelvic inflammatory disease and presented with sudden severe left-sided pelvic pain. Endovaginal sonogram reveals dilated tortuous left fallopain tube (T). Because of severe clinical symptoms, laparoscopy was performed and revealed torsion of hydrosalpinx. Left ovary was normal.

View larger version (93K): [in a new window]   Fig. 4. —26-year-old woman with severe acute right lower quadrant pain and ovarian torsion of cystic teratoma. Transverse transabdominal sonogram shows complex cystic mass in right lower quadrant with echogenic mural nodule (arrow) and adjacent fine echogenic debris. Surgery revealed ovarian dermoid cyst and adnexal torsion.

View larger version (158K): [in a new window]   Fig. 5. —30-year-old pregnant woman with surgically proven ovarian torsion. Endovaginal sagittal sonogram reveals enlarged left ovary (calipers). Focal hyperchoic area (arrowhead) corresponds to hemorrhage or edema. Color flow Doppler image (not shown) revealed absence of intraovarian flow.

View larger version (159K): [in a new window]   Fig. 6A. —22-year-old woman with ovarian torsion. Endovaginal sagittal sonogram reveals enlarged right ovary (calipers) with heterogeneous echo texture and thickened and dilated fallopian tube (arrows).

View larger version (134K): [in a new window]   Fig. 6B. —22-year-old woman with ovarian torsion. Black-and-white photograph of color Doppler image with spectral tracing reveals preserved venous flow in central ovary. Surgery detected right adnexal torsion, but viable right ovary.

View larger version (175K): [in a new window]   Fig. 7A. —26-year-old woman with right-sided pelvic pain and surgically proven ovarian torsion. Endovaginal sonogram shows enlarged right ovary (ovarian volume, 51 cm3) with many peripheral follicles.

View larger version (92K): [in a new window]   Fig. 7B. —26-year-old woman with right-sided pelvic pain and surgically proven ovarian torsion. Spectral Doppler tracing reveals arterial flow; however, presence of arterial flow did not exclude diagnosis of ovarian torsion.

View larger version (135K): [in a new window]   Fig. 8A. —32-year-old woman with acute pelvic pain caused by hemorrhagic ovarian cyst. Transverse (A) and sagittal (B) endovaginal sonograms show complex intraovarian cyst (C) surrounded by rim of healthy ovarian tissue. Cyst contains retracting clot. Calipers indicate boundary of ovaries.

View larger version (139K): [in a new window]   Fig. 8B. —34-year-old woman with acute pelvic pain caused by hemorrhagic ovarian cyst. Transverse (A) and sagittal (B) endovaginal sonograms show complex intraovarian cyst (C) surrounded by rim of healthy ovarian tissue. Cyst contains retracting clot. Calipers indicate boundary of ovaries.

View larger version (151K): [in a new window]   Fig. 9A. —26-year-old woman with ruptured hemorrhagic ovarian cyst and hemoperitoneum. Sagittal transabdominal sonograms reveal complex free echogenic fluid (f, A) in pelvis (posterior to uterus) and fluid in Morison's pouch (arrows, B).

View larger version (143K): [in a new window]   Fig. 9B. —26-year-old woman with ruptured hemorrhagic ovarian cyst and hemoperitoneum. Sagittal transabdominal sonograms reveal complex free echogenic fluid (f, A) in pelvis (posterior to uterus) and fluid in Morison's pouch (arrows, B).

View larger version (138K): [in a new window]   Fig. 9C. —26-year-old woman with ruptured hemorrhagic ovarian cyst and hemoperitoneum. Endovaginal sonogram reveals hemorrhagic right ovarian cyst (arrow) with thin internal septations.

View larger version (190K): [in a new window]   Fig. 10A. —49-year-old woman with fever, left lower quadrant pain caused by acute diverticulitis, and pericolic abscess. Transabdominal sonogram of left lower quadrant shows complex fluid collection (solid arrows) and multiple echogenic foci with shadowing (open arrow).

View larger version (171K): [in a new window]   Fig. 10B. —49-year-old woman with fever, left lower quadrant pain caused by acute diverticulitis, and pericolic abscess. Endovaginal sonography reveals presence of gas (open arrow) in fluid collection (solid arrows).

View larger version (154K): [in a new window]   Fig. 10C. —49-year-old woman with fever, left lower quadrant pain caused by acute diverticulitis, and pericolic abscess. Enhanced CT scan reveals thick-walled abscess with rim enhancement (arrows).

View larger version (88K): [in a new window]   Fig. 11. —44-year-old woman with right lower quadrant pain caused by surgically proven acute appendicitis. Transabdominal sonogram shows thick-walled dilated appendix with small appendicolith (arrow).

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