3. • When evaluating the adnexa, attempt should be first
made to identify the ovaries
• Once identifies, they should be used as reference point
• Ovaries should be examined in 2 orthogonal planes
• Ovaries may not be identified in cases before and after
puberty
4. • The normal fallopian tubes are not identified
• If any pathology is seen, size and sonographic nature of
the lesion should be documented
• Spectral , color and power doppler examination should
be performed
• Finally cul-de-sac should be examined posterior to the
uterus
52. • Movement of particulate matter within fluid due to energy
transfer when ultrasound wave is directed to it
• Hold the transducer still and then view movement of
particles AWAY from the transducer
• Can be demonstrated in cysts with fluid containing low
level echogenicity
53. • Presence of acoustic streaming means that the fluid is
less viscous
• Thus, it is not seen in Endometriomas
• Used as a test to distinguish endometriomas
56. • Age • Irregular internal cyst
• Personal history of walls
ovarian cancer • Presence of purely solid
• Largest diameter of the tumor
lesion • Color score
• Largest diameter of • Presence of acoustic
largest solid component shadows
• Presence of ascites • Current Hormonal
• Presence of flow in therapy
papillary projections • Pain during examination
57.
58. • Score > 9 suspicious of malignancy
• Additional risk factors
• Mean diameter > 10 cm
• Bilaterality
• Presence of ascites
• RI < 0.6
• Serum CA 125 >35 IU/mL
59.
60. • 1 point each for • Total score= 0 U=0
• Unilocular • Total score=1 U=1
• Solid areas
• Total score=>2 U=3
• Bilateral
• Ascites
• Intra abdominal Mets
64. RMI score Risk
<25 Low
25-250 Moderate
>250 High
65.
66. • Pelvic Congestion Syndrome postulated as cause of
chronic pelvic pain
• Venography is the gold standard
• However, ultrasound can still be used for diagnosis
67. • Dilated ovarian vein > 5 mm
• Tortuous veins around ovary and uterus (> 5mm)
• Venous plexus crossing from one side to another
• Change of flow direction with Valsalva maneuver
• Increase in size of veins with Valsalva maneuver
68.
69.
70.
71.
72.
73. • Enlargement of the
ovary
• Abnormal ovarian
position anterior to
the uterus
• Free fluid in the
pouch of Doughlas
74. • Coiling for blood
vessels on 2D and
colour Doppler