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Q. USG suggests cyst on ovary or hydrosalpinx. What does it mean?

Answered by
Dr. Padmesh Jain
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 04, 2020

Hello doctor,

I need a second opinion on my ultrasound result.

Transvaginal ultrasound reveals cyst on ovary or hydrosalpinx? Ultrasound was done on day 9 of menstrual cycle. I stopped taking birth control 5 months ago. I am currently not taking any medication. Perhaps you have another opinion or have other findings. Thank you.

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#

Hello,

Welcome to icliniq.com.

I have gone through your brief clinical history and the images you have provided. (attachment removed to protect patient identity).

Though I would like you to answer a few more questions so as to provide you better diagnosis and suggest appropriate management. Are your menses regular? Is the flow normal, heavy or low? Do you have children? Normal delivery or cesarean sections? Any abortion, miscarriage or D and C done? Any history of urogenital infection or chronic discharge per vaginum?

Now coming onto your query and analysis of the images you have sent.

First image shows anterverted uterus with a 3.9 mm calcific focus in endometrial region. This calcification is most likely due to earlier infective or inflammatory pathology. Nothing to worry about.

Second image shows minimal amount of clear fluid in the endometrial canal with thin endometrium for 9th day of cycle.

Third, Fourth and fifth images show an oblong soft tissue structure adjacent to the left ovary. This could either be part of the bowel or fallopian tube (I can differentiate it on a dynamic scan or an ultrasound video rather than a still image).

The left ovary looks normal with few follicles seen within it. No obvious cyst is seen in the image provided. Also, the left tube is not dilated and therefore no hydrosalpinx is seen.

The last sixth image shows part of normal bowel loop in the right adnexa. No right ovary or dilated tube is seen in the image provided.

I hope this helps.


The Probable causes:

Infective - inflammatory.

Investigations to be done:

Hormonal assays serum FSH (follicle stimulating hormone), LH (lutenizing hormone), prolactin and androgen levels.
complete blood count,
Ruined routine and microscopy.
SOS PAP smear

Regarding follow up:

Follow up with reports.

Thank you doctor,

The report I received from the initial radiologist suggest possible left complicated cyst versus hydrosalpinx. However, you do not suggest hydrosalpinx? What is the cause of this clear fluid in the endometrial canal? Is it safe to get pregnant? Will this fluid leak into uterus and cause issues during pregnancy?

I have a history of chlamydia and possibly had this for 10-11 months before antibiotic treatment. I no longer have this infection as it has been treated.

I have included a few more photos I had forgotten to attach.

Answer to your questions:

Yes, my menses are regular every 27-30 days. I have very low flow, sometimes only one day and spotting usually a few days before period. I will also have spotting after intercourse sometimes one week before period. I have no children and trying to conceive for four months. I have not done any abortion or D and C. I had chronic UTI's in the past and bacterial vaginosis.

#

Hello,

Welcome back to icliniq.com.

So what I suspected was right that you have a history of chronic genital infection which in your case is chlamydia. Fortunately, you seem to have taken a complete course of treatment for the same. However, these chronic infections are notorious to cause tubal block.

I am into medicine since 21 years and have been doing gynecology ultrasound scans for almost a decade now. The finding of mild endometrial fluid is mostly innocuous and not uncommon and most of the cases resolve on their own or after a short course of antibiotics and anti-inflammatory medicines.

In the three images provided (attachment removed to protect patient identity), the soft tissue measured in the left adnexa appears to be normal tissue. The black structure below the left ovary is mostly internal iliac vessel which supplies blood to the left ovary. The ovary appears normal in the image provided with few follicles within.

As you are keen on conception, we need to check for your fertility status for which a battery of blood tests are required viz, FSH, LH, estradiol, inhibin, prolactin, insulin and testosterone.

Since you have a history of chlamydia, chronic UTIs (urinary tract infection) and bacterial vaginosis we would like to check the patency of tubes. For this purpose, a test called HSG (hysterosalpinography) or sono-hysterosalpingography is advised.


The Probable causes:

Chronic genitourinary infection.

Investigations to be done:

Blood tests FSH, LH, estradiol, inhibin, prolactin, insulin and testosterone.

HSG (hysterosalpingography) or sono-hysterosalpingography.

Great - would the antibiotic doxycycline be recommended to take right now to treat mild endometrial fluid and my current issues? Is there a chance this fluid leaks into my uterus if I get pregnant and potentially cause miscarriage?

My FSH test came back normal. I will look into the others you recommended. My last question - You mentioned minimal amount of endometrial canal with THIN endometrium for 9th day of cycle.. this measured 2mm for me at this time correct, based on my ultrasound photo? I know in order to have successful implantation this needs to be at least 8mm in thickness. Do you suspect that mine reaches this considering it is only 2mm on day 9 of my cycle?

Thanks again for your help.
# Greetings dear Katlin,

This fluid has negligible chances of causing miscarriage if you get pregnant.

Yes, A course of tab. Doxycycline along with anti-inflammatories such as aceclofenac + serratiopeptidase may help in getting rid of the fluid and infection if any.

Yeah, you are right that your endometrial thickness should be atleast 8 mm for conception. It is like a bed where the fertilized egg will get implanted and grow. Therefore is needs to be sufficiently thick enough to support that. Mostly doctors here start the patient on progesterone medications to support the endometrial thickness and thereby avoiding chances of spontaneous miscarriage. since your endometrial thickness is low , you will require the same.

Do you suspect that mine reaches this considering it is only 2mm on day 9 of my cycle?...LESS likely

I suggest you get a "transvaginal ultrasound follicle and endometrial monitoring study" done for atleast two cycles. That will give an idea if your follicles are growing and rupturing at the right time to release the egg. Also, it will monitor your endometrial thickness on corresponding days.

Yes, do send me the hormonal assay report to give you a better idea regarding your fertility status.

If possible , send me full ultrasound report which mentions the dimensions of the uterus and ovarian volumes.

Kindly give a 5 star feedback rating, if you are happy and satisfied with the replies to your queries.

Best wishes
Warm Regards,
Dr. Padmesh Jain
The Probable causes:

hormonal,
constitutional,
infection

Investigations to be done:

transvaginal ultrasound follicle and endometrial monitoring study.

HSG


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