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Tammy T. ChangGillian Lieberman, MD
Radiologic Evaluation of Complex Adnexal Mass
Tammy T. Chang, Harvard Medical School Year IIIGillian Lieberman, MD
August 2001
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Tammy T. ChangGillian Lieberman, MD
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AgendaTo discuss:
•Anatomy of Female Pelvis
• Radiologic Modalities Used to Evaluate the Female Pelvis
• Differential Diagnosis of Complex Mass in the Female Pelvis
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Tammy T. ChangGillian Lieberman, MD
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Female Pelvic Anatomy
http://www.bartley.com/107/illus1165.html
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Tammy T. ChangGillian Lieberman, MD
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Hysterosalpingogram
http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html
Fallopian Tube
Uterine Cavity
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Tammy T. ChangGillian Lieberman, MD
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Ms. L, 31-years-old, presents with
right lower quadrant pain
Our Patient:
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Tammy T. ChangGillian Lieberman, MD
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Radiological Modalitiesfor Evaluation of Female PelvisUltrasound
TransabdominalTransvaginal
Magnetic ResonanceImaging
ComputedTomography
Noionizing radiation and
i.v. contrast
Noionizing radiation and
i.v. contrast
Ionizing radiationand i.v. contrast
Initial evaluation Surgical evaluation Staging for ovariancancer
Differentiates cysticfrom solid lesions
Best typifiesNature of lesion
Evaluates sizableovarian masses
Swartz, L.B. and Seiger, D.B. 1992. J Repro Med 37:63-71
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Tammy T. ChangGillian Lieberman, MD
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Our Patient’s pelvic ultrasound
Courtesy of Dr. Chad Brecher, M.D. Complex Mass
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Tammy T. ChangGillian Lieberman, MD
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Complex Mass
Normal Ovary
Courtesy of Dr. Chad Brecher, M.D.
Our Patient’s complex adnexal mass
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Tammy T. ChangGillian Lieberman, MD
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Differential Diagnosis forComplex Adnexal Mass
BenignCystadenomaHemorrhagic cystEndometriomaTeratoma
MalignantOvarian Carcinoma
EpithelialGerm cellStromal
OtherEctopic pregnancyAbscessHematoma
Uterin OriginSubserosal uterin fibroid
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Tammy T. ChangGillian Lieberman, MD
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Courtesy of Dr. Chad Brecher, M.D.
AscitesHydroureter
Our Patient: Axial Abdominal CT
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Tammy T. ChangGillian Lieberman, MD
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Pelvic Mass
Courtesy of Dr. Chad Brecher, M.D.
Our Patient: Pelvic CT
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Tammy T. ChangGillian Lieberman, MD
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Mass
Uterus
BladderCourtesy of Dr. Chad Brecher, M.D.
Our Patient: Coronal CT
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Tammy T. ChangGillian Lieberman, MD
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Let’s Review the characteristic appearance of some other adnexal masses
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Tammy T. ChangGillian Lieberman, MD
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Patient 2: Ultrasound of Simple Cyst
BIDMC PACS
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Tammy T. ChangGillian Lieberman, MD
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Patient 3: T1-weighted MR
Mass
Uterus
Bladder
http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html
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Tammy T. ChangGillian Lieberman, MD
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Patient 3: Fat-suppression MR
Endometrioma Teratoma
http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html
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Tammy T. ChangGillian Lieberman, MD
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Conclusion
• US and MR - major modalities for evaluating female pelvisCT - role in staging ovarian cancer
• Current imaging are non-specific in distinguishing between benign and malignant complex masses
• Some techniques allow definitive diagnosis of characteristic masses e.g. fat-suppressing MR identifies teratomas from hemorrhagic cysts or endometriomas
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ReferencePublications• Kawamoto, S., Urban, B.A., Fishman, E.K. CT of epithelial ovarian tumors. Radiographics 1999; 19:S85-S102.• Occhipiniti, K.A., Frankel, S.D., Hricak, H. The ovary computed tomography and magnetic resonance imaging. Radiologic Clinics of North America 1993; 31:1115-1132.• Schwartz, L.B and Seifer, D.B. Diagnostic Imaging of Adnexal Masses A Review. J Reproductive Medicine 1992; 37:63-71.• Urban, B.A. and Fishman, E.K. Helical (spiral) CT of the female pelvis. Radiologic Clinics of North America 1995; 33:933-948.• Woodward, P.J. and Gilfeather M. Magnetic resonance imaging of the female pelvis. Seminars in US, CT, and MRI 1998; 19:90-103.
Web Resources• Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febifer, 1918; Bartleby.com, 2000. www.bartleby.com/107/illus1166.html. [9/14/01]• http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html• http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html
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Tammy T. ChangGillian Lieberman, MD
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Acknowledgements
Chad Brecher, M.D.Larry BarbarasCara Lyn D’amourPamela Lepkowski
Gillian Lieberman, M.D.