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Radiology
Ovarian and Other Adnexal Masses in Pregnancy
Built from Obstetric Imaging
What’s inside
11 sections · 111 slides
Overview
- What this deck covers
Starting with the words
What an adnexal mass is, and why pregnancy changes the question
- A lump beside the uterus
- Why these lumps form
- Why we find so many of them now
- >90%
- Most simply go away
- Benign does not mean harmless
- What the complications mean in practice
- Which masses are still there later in pregnancy
- Prevalence of Persistent Adnexal Masses in Pregnancy
Sorting the causes
Rule out the neighbours, then sort by the structure the mass came from
- First question: is it even gynaecological?
- Then sort by where it grew from
- Each group splits again
- Pattern recognition: the core scanning skill
- A quick map of the differential
- Adnexal masses in pregnancy: what each one is
- Adnexal masses in pregnancy: what each one looks like on ultrasound
- Adnexal masses in pregnancy: how each one is managed
Ovarian cysts
The largest group by far, and mostly the least worrying
- The simple cyst
- Thin-walled black cyst in the ovary
- The corpus luteum: a cyst with a job
- Ring of blood flow around a corpus luteum
- Reading the ring of fire
- Follicular and haemorrhagic cysts
- How a cyst that bleeds changes on screen
- Complex cyst with strands inside
- Endometrioma: womb lining in the wrong place
- Even grey haze filling an ovarian cyst
- The endometrioma trap in pregnancy
- Endometriomas can misbehave
- Mature teratoma, the "dermoid cyst"
- Bright lump that casts a shadow
- Cystadenomas: benign, but not to be forgotten
- Why cystadenomas earn repeat scans
- Multi-compartment cyst with hazy fluid
- Reading the mucinous cyst
- Single clear-fluid cyst in the ovary
- Reading the serous cyst
- What surgery series actually found
When it could be cancer
Uncommon, usually caught early, but never assumed away
- How common is ovarian cancer in pregnancy
- A different mix of tumours from usual
- Inside the two big groups
- Ultrasound signs that raise concern
- Thick irregular wall with solid tissue
- Large cyst with a nodule on its wall
- Reading the wall nodule
- Reassuring versus worrying on ultrasound
- Sorting masses by risk
- Features of Adnexal Masses at High and Low Risk for Malignancy
Masses made by pregnancy itself
Two entities that appear because of pregnancy hormones and fade afterwards
- Theca-lutein cysts
- When to expect theca-lutein cysts
- Both ovaries filled with many thin-walled cysts
- Reading the multicystic ovary
- Luteoma of pregnancy
Tubes, uterus and look-alikes
Not everything in the adnexa comes from the ovary
- Blocked, fluid-filled tubes
- Winding tube with false partitions
- Paratubal and paraovarian cysts
- Ectopic and heterotopic pregnancy
- Fibroids that stick out sideways
- Solid whorled mass beside the uterus
- Not mistaking a fibroid for an ovarian mass
How patients present
Mostly silently — and the loud presentations carry more risk
- Most women feel nothing at all
- The acute presentations
- Pressure symptoms from a big mass
- Other causes of acute pelvic pain to keep in mind
- When infection is the cause
- Abnormal blood results as the first clue
Imaging the mass
Ultrasound first, Doppler with caution, scoring systems and MRI to help
- Ultrasound is the foundation
- What a good description records
- Large septated mass with solid areas and bright fluid
- Reading the suspicious mass
- Doppler: useful, but oversold
- Prediction models: turning features into a verdict
- IOTA Simple Rules: three possible verdicts
- How the rules work in practice
- The ten features side by side
- IOTA Simple Rules
- O-RADS: a grading scale, like mammograms
- The extra O-RADS categories
- Do these scores work in pregnancy?
- Scoring systems validated in pregnancy: how well they perform
- Scoring systems validated in pregnancy: what each one looks at
- Scoring systems compared, as printed in the source
- Imaging clues to future trouble
- Where MRI helps
Watch or operate
Management still divides clinicians, so the reasoning matters more than a rule
- The management principle
- Why tumour markers do not help here
- Who can simply be watched
- Who should be considered for surgery
- Surgery in pregnancy carries its own risk
- What will not wait
- Why the early second trimester is the sweet spot
- Timing in the real world
- Laparoscopy: the preferred route
- Laparoscopy needs adjusting for pregnancy
- When malignancy is likely, open surgery
- A mass found during a caesarean
- It is a team decision
Pulling it together
What to carry away from this topic
- The takeaways
- The takeaways, continued
- How the pieces fit together
- References
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- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition