Chapter 14 - Pelvic Pathology Presentations

Paraovarian Cyst

This type of cyst is generally asymptomatic and the patient will present with pelvic pain if large. Occur in the broad ligament, it is a single, unilocular mass with papillary projects present in 30% of the lesions.

Ovarian Torsion

A 17 year old female arrives at the emergency department with severe lower abdominal pain, nausea and vomiting, and leukocytosis. After having a ultrasound study, a enlarged, hypoechoic ovary with peripherally displaced follicles is found. What type of emergency is this?

Immature Teratomas

A 19 year old woman had an ultrasound exam of her pelvis. A solid/mixed heterogeneous adnexal mass with calcifications, 23cm in size, is found. What type of mass is this?

Mature (Cystic) Teratoma

A 21 year old woman had an ultrasound exam of her pelvis and a cystic mass with a dense, echogenic tubercle projecting into the lumen. What type of mass is this?

Leiomyoma/Myoma/Fibroid

A 24 year old complains of heavy flow cycles and mid-cycle pelvic pain. During examination, a palpable mass is noted. A ultrasound examination shows a well-circumscribed, hyperattenuating mass in the uterus. What is found?

Dysfunctional Uterine Bleeding

A 25 year old patient arrives to the emergency department complaining of abnormal vaginal bleeding. An ultrasound is performed, but no structural abnormalities present. What could this patient be diagnosed with?

Dysgerminoma

A 25 year old woman had an ultrasound which shows a large, solid, encapsulated mass with central hemorrhage and necrosis. Color Doppler demonstrated vascular flow within the solid components. What type of mass is this?

Endometritis

A 27 year old patient is presenting a fever, uterine tenderness, and slight leukocytosis. After taking her history, she just gave birth a week prior and had a prolonged labor. After completing her ultrasound, air bubbles and fluid are in her endometrial cavity. What is this patient diagnosed with?

Uterine Polyps

A 29 year old patient presents with a history of heavy menstrual periods and an inability to conceive for the past three years. Sonography reveals endometrial thickening that is difficult to differentiate from endometrial hyperplasia, and a vascular pedicle demonstrated with color Doppler. What is the most likely diagnosis?

Pelvic Inflammatory Disease

A 29 year old patient presents with fever, elevate RBC count, and complaints of severe pain in her lower left quadrant. An ultrasound showed signs of free fluid in the cul-de-sac, endometrial cavity thickening, and enlarged, ill-defined ovaries. What is the patient diagnosed with?

Endometritis

A 30 year old woman arrives to the emergency department with pelvic pain and a fever. The ultrasound shows a thickened, heterogeneous endometrium along with echogenic foci in the endometrium cavity. What is this patient presenting with?

Asherman Syndrome

A 31 year old patient presents with pelvic pain, amennorhea, and has uterine adhesions. What acquired anomaly would this patient be diagnosed with?

Leiomyoma/Myoma/Fibroid

A 32 year old African American woman complains of heavy menstrual flow, frequent urination, and dyspareunia. An ultrasound shows a uterine mass with calicification on or within the periphery. What type of mass does this patient have?

Adenomyosis

A 32 year old, mother of three, with prior history of uterine fibroids presents with midline dyspareunia and menorrhagia. The ultrasound shows a heterogenous uterine myometrial texture with focal cystic areas. The endometrium and myometrium interface is indistinct. What is this patient presenting with?

Adenomyosis

A 37 year old woman presents with heavy menstrual periods and complains of dyspareunia. A pelvic exam reveals a symmetrically enlarged uterus with normal contours. What is the most likely diagnosis?

Adenomyosis

A 38 year old patient complains of menorrhagia and the ultrasound shows a symmetrically enlarged uterus with bulkiness in the posterior wall. What type of mass is present?

Endometrial Hyperplasia

A 42 year old patient that is taking Tamoxifen presents with vaginal bleeding. A homogenous appearance of the endometrium is seen on an ultrasound as well as a 16mm endometrial circumference is noted. The patient is sent for a biopsy. What diagnoses can be made?

Endometrial Carcinoma

A 46 year old woman presents arrives to the clinic with a history of hypermenorrhea a familial history of uterine cancer. Her endometrium is poorly defined with irregular contours. What is this patient diagnosed with?

Fibroma/Thecoma

A 48 year old woman has a hypoechoic adnexal mass with enhanced acoustic attentuation resulting in an acoustic shadow. What type of mass is this?

Leiomyosarcoma

A 53 year old patient complains of vaginal bleeding and a palpable mass is found during examination. A ultrasound is performed and a large, heterogenous, hypoechoic uterine mass is found. The sonographer places Doppler over the mass and it is noted that there are high-velocity, low-resistance waveforms in the feeding vessels. What type of malignant finding corresponds to these findings?

Transitional Cell (Brenner) Tumor

A 55 year old woman had a routine check up and a palpable mass was found. She was sent for an ultrasound and a solid, hypoechoic ovarian mass was found. It had calcifications and casted an acoustic shadow. What type of mass is this?

Endometrial Carcinoma

A 62 year old woman a history of early menarche and diabetes mellitus, complains of pelvic pain and vaginal bleeding. Her ultrasound shows an increased uterine size and an alteration of size/shape/sonographic texture of the myometrium. What is the diagnosis?

Endometrial Carcinoma

A 65 year old postmenopausal patient presents with sudden onset of vaginal bleeding. She is not on HRT and has been asymptomatic for gynecologic problems. What is the most likely diagnosis?

Endometrial Polyps

A 65 year old woman presents with postmenopausal bleeding. A ultrasound shows a discrete mass in her endometrium and a vascular pedicle is demonstrated with color Doppler. What diagnosis can be made?

Corpus Luteum Cyst

A complex, cystic appearing mass is found in a patient complaining of local pain and tenderness, along with amenorrhea. What type of cyst is this?

Leiomyosarcoma

A patient arrives to the clinic to have a follow up exam of a palpable mass that was found. She is complaining of increased pelvic discomfort and continued irregular menstrual flow. What type of mass is this patient diagnosed with?

Malignant Epithelial Tumor

A patient arrives to the clinic with a diagnosis of Cushing's syndrome in conjunction with vaginal bleeding. The ultrasound shows a mass with irregular borders, Doppler flow, and ascites. What type of mass is this?

Benign Epithelial Tumor

A patient arrives to the clinic with an elevated serum CA-125 level, hypercalcemia, and hyperthyroidism. The ultrasound exam shows a smooth-bordered, anechoic mass with internal calcifications, and absent of internal blood flow. What type of mass is this?

Dysfunctional Uterine Bleeding

A patient is presenting with abnormal vaginal bleeding yet does not have any structural abnormalities and does not show any pathologic causes. There are no sonographic findings. What is this patient diagnosed with?

Chronic Hemorrhagic Cyst

A patient presents with a sudden onset of pelvic pain and upon examination, a palpable adnexal mass is found. An ultrasound shows absent blood flow within the internal solid components and is a complex, predominantly cystic mass with thick walls. What type of cyst is this?

Corpus Luteum Cyst of Pregnancy

A patient presents with delayed menses and tenderness in the ovary. A large adnexal mass with posterior acoustic enhancement is found, exhibiting thickened, irregular borders. What type of cyst is this?

Follicular Cyst

A patient presents with pelvic pain, dyspareunia, and occasional vaginal bleeding. An anechoic, smoothly marginated mass measuring 5cm is found. What type of cyst is this?

Krukenberg Tumor

A patient presents with vaginal bleeding, hirsutism, and virilzation. A bilateral, solid ovarian mass is found during a ultrasound, with a "moth-eaten" appearance.

Theca-Lutein Cyst

A patient with PCOS arrives with an elevated serum beta-hCG and complains of pelvic fullness. There are muliple large cysts and a multiocular, septated internal architecture. What type of cyst is this?

Pseudomyxoma Peritonei

A patient with hyperthyroidism has ascites with echogenic particulate matter, and displaced small bowel loops. What type of mass is present?

Endometrial Hyperplasia

A postmenopausal obese woman is complaining of vaginal bleeding. Her endometrium has a homogeneous appearance with cystic changes along with an increased thickness of her endometrial stripe. What condition is this patient diagnosed with?

Ovarian Vein Thrombosis

A postpartum woman that had a cesarean section arrives to the emergency room complaining of right-sided abdominal pain and has a fever. An ultrasound shows absent blood flow and a tortuous tubular structure ascending from the adnexa to the IVC. What is the diagnosis?

Acute Hemorrhagic Cyst

A thin-walled, smoothly marginated cyst with a posterior acoustic enhancement is found on an ultrasound with a patient that complains of sudden pelvic pain. There are diffuse low-level echoes within the lumen that may swirl.

Asherman Syndrome

A woman presents to the emergency room with hypomenorrhea and has a history of spontaneous abortions. She has also had 2 preterm deliveries. The ultrasound shows a thickened endometrium and intrauterine synechiae on hysterosonography. What is the diagnosis?

Endometriosis

A woman presents with dysmenorrhea, dyspareunia, dyschezia, and pain during exercise. A well-circumscribed cystic mass with posterior acoustic enhancement, along with thin or thick septations are present on a sonogram. What is this patient diagnosed with?

Polycystic Ovary Syndrome

An obese patient presents with a history of infertility and hirsutism. The ultrasound exam shows a presence of more than 10 follicles. What is this patient diagnosed with?