HEMORRHAGIC OVARIAN CYST IN USS

Views:
 
Category: Education
     
 

Presentation Description

MEDICAL EDUCATION

Comments

Presentation Transcript

HEMORHAGIC OVARIAN CYST: One entity with many sonographic appearances :

HEMORHAGIC OVARIAN CYST: One entity with many sonographic appearances Ahmed zaki , msC , mrcog ALEX-SYDENY-KIEL HOSPITAL

CORPUS LUTEUM:

CORPUS LUTEUM

H.CL. CYST:

H.CL. CYST

Corpus luteum cyst :

Corpus luteum cyst A corpus luteum may seal and fill with fluid or blood, forming a corpus luteum cyst . TVS show a small complex ovarian cyst with wall vascularity on power Doppler. The characteristic circular Doppler appearance is called the 'ring of fire'. Note , there is good through-transmission and no internal vascularity , consistent with a, partially involuted , corpus luteum cyst . Remember that women who are on birth control pills usually won't form a corpus luteum, as birth control pills prevent ovulation. On the other hand, use of fertility drugs that induce ovulation, increases the chance of developing corpus luteum cysts.

HOC When a Graafian follicle or follicular cyst bleeds, a complex hemorrhagic ovarian cyst (HOC) is formed. :

HOC When a Graafian follicle or follicular cyst bleeds, a complex hemorrhagic ovarian cyst (HOC) is formed. HOC presents classically as an unilocular cyst with fibrin-strands or low-level echoes good through transmission. Variable pattern of internal echogenicty that changes over the time (clot get resolved within 6-8 weeks) HOC have variable wall thickness , regular wall,with color flow No internal vascularity Clinically the classic presentation is with acute pain. However HOC can also be an incidental finding in an asymptomatic patient.

Presenting characteristics can include: reticular (lacy, cobweb, fishnet) internal echoes due to fibrin strands solid-appearing area with concave margins :

Presenting characteristics can include: reticular (lacy, cobweb, fishnet) internal echoes due to fibrin strands solid-appearing area with concave margins

Clot can be like spider web:

Clot can be like spider web

US appearance is variable: :

US appearance is variable:   Acute phase : hyperechoic avascular cyst of heterogeneous or homogeneous echo structure Subacute phase : A reticular pattern of thin internal echoes due to fibrin strands and absence of detectable flow at Doppler US Phase of clot retraction : solid avascular mass with concave outer margin The presence of echogenic free fluid in peritoneal cavity indicates leaking or rupture of cyst Clinic : Acute pelvic pain. Solved in 8 weeks.

Color Doppler image showing circumferential flow in the cyst wall (arrows) and no flow in the septations or echoes within the cyst.:

Color Doppler image showing circumferential flow in the cyst wall (arrows) and no flow in the septations or echoes within the cyst.

HOC W RETRACTING CLOT: solid-appearing component anterior (arrowheads) and anechoic fluid posterior.:

HOC W RETRACTING CLOT: solid-appearing component anterior (arrowheads) and anechoic fluid posterior.

HOC WITH RETRACTING CLOT:

HOC WITH RETRACTING CLOT NO FLOW.. CLOT SOLID MASS WITH FEEDING BV..?? NEOPLASM

Hoc, notice absence of flow and good through transmission- arrow:

Hoc, notice absence of flow and good through transmission- arrow

: on both sides (RT &LT OVARIES),there is what appears to be a solid lesion. good through transmission, On Doppler US (not shown) there was no vascularity.:

: on both sides (RT &LT OVARIES),there is what appears to be a solid lesion . good through transmission, On Doppler US (not shown) there was no vascularity.

HOC, DEPENDENT HGIC SEDMENT:

HOC, DEPENDENT HGIC SEDMENT No INTERNAL flow Fluid-fluid level , bottom one is hyperechoic

Slide33:

The pattern of septations is sometimes described as weblike or lacy. fluid within the cyst often has scattered echoes. The walls of a hemorrhagic cyst may be thin and smooth, or they may be focally or diffusely thickened. No blood flow should be seen within the cyst or its septations , but flow may be seen in its walls

Slide34:

SIMPLE OVARIAN CYST HOC

Simple ovarian cyst. A:demonstrating a simple ovarian cyst B: Color Doppler image of cyst showing no internal blood flow nor flow in the thin, smooth wall of the cyst.:

Simple ovarian cyst. A:demonstrating a simple ovarian cyst B: Color Doppler image of cyst showing no internal blood flow nor flow in the thin, smooth wall of the cyst.

Slide49:

HOC are normal in ovulatory women, usually resolving within 8 weeks. They can be quite variable in appearance, however, and can be confused with ovarian endometrioma .

the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement indicates::

the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement indicates:

Complications of HOC:

Complications of HOC

HOC:

HOC Larger HOC in the early OR late menopause should be considered possibly neoplastic and MRI or surgical evaluation should be considered.

Management.:

Management. the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement indicates : For premenopausal women : No follow-up imaging needed unless there’s an uncertain diagnosis or if the cyst is larger than 5 cm. Cyst size > 5 cm; short-interval follow-up ultrasound is indicated (6-12 weeks ) For recently menopausal women : Follow-up ultrasound in 6 to 12 weeks to ensure resolution of the initial findings For later postmenopausal women : Cyst possibly neoplastic; consider surgical removal

A: Image of ovary demonstrating a HOC(arrows) with septations, echoes in the fluid, and blood flow in the wall. B: On follow-up scan 6 weeks later, the HOC is smaller, there are fewer septations, and the septations are thinner.:

A : Image of ovary demonstrating a HOC(arrows ) with septations , echoes in the fluid, and blood flow in the wall. B: On follow-up scan 6 weeks later , the HOC is smaller, there are fewer septations , and the septations are thinner.

Slide61:

Simple cysts are uniformly hypoechoic, with thin walls and no blood flow on color Doppler (FIGURE 1 ) . Hemorrhagic cysts produce lacy/reticular echoes and clot with concave margins (FIGURE 2 ). Mature cystic teratomas produce hyperechoic lines and dots, sometimes known as “dermoid mesh,” acoustic shadowing, and a hyperechoic nodule (FIGURE 3 ). Endometriomas produce diffuse, low-level internal echoes and a “ground glass” appearance (FIGURE 4).

Characteristics of simple cysts :

Characteristics of simple cysts A simple cyst typically is round or oval, anechoic, and has smooth, thin walls. It contains no solid component or septation (with rare exceptions), and no internal flow is visible on color Doppler imaging.Levine and colleagues observed that simple adnexal cysts as large as 10 cm carry a risk of malignancy of less than 1%, regardless of the age of the patient. In its 2010 Consensus Conference Statement,1 the Society of Radiologists in Ultrasound recommended the following management strategies for women with simple cysts:

MX SIMPLE CYST:

MX SIMPLE CYST Reproductive-aged womenCyst <3 cm: No action necessary; the cyst is a normal physiologic finding and should be referred to as a follicle.3–5 cm: No follow-up necessary; the cyst is almost certainly benign.5–7 cm: Yearly imaging; the cyst is highly likely to be benign.>7 cm: Additional imaging is recommended.Postmenopausal women<1 cm: No follow-up necessary; the cyst is almost certainly benign.1–7 cm: Yearly imaging; the cyst is likely to be benign.>7 cm: Additional imaging is recommended.

authorStream Live Help