Imaging Pearls ❯ OB GYN ❯ Incidental Lesion in Ovary
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- “ Mature cystic teratomas, often referred to as dermoids, are the most common benign ovarian neoplasm and the most common neoplasm responsible for ovarian torsion. They frequently present with acute pain owing to rupture or torsion. If free fluid is present in the setting of a dermoid and acute pain, rupture should be considered. Pain re- sults from a chemical peritonitis secondary to leak- ing of the oily material of dermoids.”
Acute Gynecologic Disorders Carolyn K. Donaldson Radiol Clin N Am 53 (2015) 1293–1307 - “Tip of the iceberg” is a term used to describe the ultrasonographic findings of a dermoid. Dermoids can contain large fatty components that absorb the sound beam, preventing adequate evaluation of the lesion. Therefore, only the anterior margin of a lesion may be imaged with US. The posterior margin is obscured. Thus, large lesions are often undermeasured. The same lesion on CT is much larger.”
Acute Gynecologic Disorders Carolyn K. Donaldson Radiol Clin N Am 53 (2015) 1293–1307 - “Dermoids do not contain internal vascularity. This is an important feature that distinguishes dermoids from malignant lesions. Dermoids are usually benign. Malignant transformation in up to 2% occurs in older women (>50 years) and in large dermoids (>10 cm). Dermoids are usually removed because of the risk of rupture, or torsion. They can grow slowly and destroy ovary. They are bilateral in 12% to 20% of cases. Dermoids may elude detection by US, but are subsequently seen on CT.”
Acute Gynecologic Disorders Carolyn K. Donaldson Radiol Clin N Am 53 (2015) 1293–1307
- “ Adherence to SRU (Society of Radiologists in Ultrasound) guidelines for management of adnexal cysts at our institution was 59%. Overmanagement generally occurred for physiologic cysts in premenopausal patients, undermanagement was observed for simple cysts in postmenopausal patients.”
US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidelines
Rosenkrantz AB, Kierans AS
Radiology 2014; 271:262-271 - “ Radiologists recommendations for management of adnexal cysts detected at US in 398 patients were adherent to SRU guidelines in 59%,(overmanagement, 27%; undermanagement, 9%; incomplete recommendation, 6%): menopausal status, cyst size and other cyst features significantly affected adherence rate.”
US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidelines
Rosenkrantz AB, Kierans AS
Radiology 2014; 271:262-271 - “ Overmanagement recommendations were made in most instances for hemorrhagic cysts (59%) and cysts with a single thin septation.”
US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidelines
Rosenkrantz AB, Kierans AS
Radiology 2014; 271:262-271 - “ Undermanagement recommendations were made for 31% of simple cysts measuring 1-7 cm in postmenopausal patients.”
US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidelines
Rosenkrantz AB, Kierans AS
Radiology 2014; 271:262-271
- “ When an incidentally identified benign appearing cyst in a woman in early postmenopause is >5cm in size, the committee recommends prompt sonographic evaluation to ensure that small wall nodules have not been overlooked”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 1: White Paper of the ACR Incidental Findings Committee II on Adnexal Findings
Patel MD et al
J Am Coll Radiol 2013;10:675-681 - “ In late postmenopause, the committee does not recommend prompt or follow-up ultrasound of an asymptomatic benign appearing cyst - 3 cm in maximum diameter.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 1: White Paper of the ACR Incidental Findings Committee II on Adnexal Findings
Patel MD et al
J Am Coll Radiol 2013;10:675-681 - “ In early postmenopause, the committee recommends prompt ultrasound for a probably cyst >3cm and in late menopause for a probably benign cyst >1 cm in maximum diameter.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 1: White Paper of the ACR Incidental Findings Committee II on Adnexal Findings
Patel MD et al
J Am Coll Radiol 2013;10:675-681