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5 - Pathology of the ovaries, fallopian tubes and adnexae

Published online by Cambridge University Press:  04 March 2010

By
Damian J. M. Tolan  and
Michael J. Weston
Edited by
Jane Bates
Damian J. M. Tolan
Affiliation:
St James's University Hospital, Leeds
Michael J. Weston
Affiliation:
St James's University Hospital, Leeds
Jane Bates
Affiliation:
St James's University Hospital, Leeds
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Summary

Introduction

Ultrasound has become an essential part of the gynaecological evaluation of the adnexae (which comprise the ovaries, fallopian tubes and broad ligament). In this chapter we will discuss the pathology, ultrasound imaging features and aspects of management of a range of conditions affecting the adnexae and conditions that may mimic adnexal pathology. We will concentrate on important or common conditions, with particular emphasis on the ovaries.

Clinical presentation

Patients referred for ultrasound examination of the pelvis may present with a range of symptoms. Pain is common and may be related to ovulation (mittelschmerz), menstruation (particularly in endometriosis) or intercourse (dyspareunia). Chronic pain may indicate pelvic inflammatory disease (PID) and acute severe pain may herald an emergency in the form of ovarian torsion or ectopic pregnancy. However some women complain of pressure rather than pain, often related to masses causing compression and displacement of pelvic organs. The close proximity of the adnexae to other organs may produce gastrointestinal or renal tract symptoms, which may misdirect the clinical evaluation away from the real cause for the complaint. Bloating and distension, though non-specific, are symptoms that may suggest ascites or massive ovarian tumours.

Alteration to the normal menstrual cycle, with irregular bleeding or amenorrhoea, and infertility or subfertility are further indicators of ovarian pathology ranging from polycystic ovary syndrome (PCOS) to hormone-secreting tumours.

Increasingly, with improvement in technology and increase in the demand for examinations, pathology is being discovered incidentally on imaging examinations for unrelated complaints.

Type
Chapter
Information
Practical Gynaecological Ultrasound , pp. 79 - 102
Publisher: Cambridge University Press
Print publication year: 2006

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