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The first 25 slides, exactly as they appear. The full deck has 111 content slides.
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