Dr. Manwani Saloni Dilip
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Kindly review my transabdominal and transvaginal ultrasound reports and give your suggestions.
1. An anteverted uterus which was normal in size, shape, and reflectivity. It measured 63 x 29 x 36 mm.
2. The endometrium was smooth in outline and of normal echotexture but expanded by transudate to a depth of 6.8 mm.
3. The anterior endometrial layer measured 1.1 mm, and the posterior endometrial layer measured 0.9 mm (total 2.0 mm, postmenopausal).
4. No color flow was noted when the color doppler was applied.
5. Within the midline extending into both the right and left adnexa, there was a complex structure measuring 138 x 102 x 133 mm. It contained cystic and solid components and had irregular internal walls and a solid and cystic area measuring 68 x 46 x 69 mm.
6. Solid, hyperechoic areas measuring 30 x 26 x 30 mm and 28 x 20 x 26 mm. There was some color flow when the color doppler was applied. There was no normal ovarian tissue seen.
7. To the left of the uterine wall and immediately posterior to the adnexal mass, there was a tubular cystic structure measuring 43 x 22 x 29 mm. It was vascular and contained complete and incomplete septations. The ultrasound appearances may be suggestive of a left hydrosalpinx. This structure appeared to be separate from the adnexal mass.
Conclusion: Ultrasound appearances of a large complex midline adnexal mass measuring 138 mm. Left hydrosalpinx, postmenopausal endometrium measuring 2.0 mm and transudate within the cavity. Clinically there is a six-week history of pinkish spotting. Otherwise, no other symptoms.
Thank you.
Hello,
Welcome to icliniq.com.
I have gone through the ultrasound report mentioned above. According to the report, there is an adxenal (next to the uterus) mass which is most probably arising from the ovary as the ovaries are not visualized separately. The mass has concerning features like solid components and large size, and postmenopausal status. You would need further evaluation, like blood tests, to determine the cause of this mass. Blood tests will include tumor markers like CA125 (cancer antigen 125), CEA (carcinoembryonic antigen), CA 19-9 (cancer antigen 9-9), and AFP (alpha-fetoprotein). Kindly do the blood tests and consult again.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
I consulted a specialist doctor, and the doctor said I would likely need a hysterectomy. Would you agree with the same suggestion?
Thank you.
Hello,
Welcome back to icliniq.com.
Hysterectomy would be the ideal treatment considering all the risk factors, and I would recommend it. However, you can also opt for an oophorectomy (surgical removal of ovaries), leaving the uterus intact, but that would have a high risk of spread and require serial monitoring.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
You have made it simpler for me to understand. I know the solid components and size is concerning. The report mentioned no free fluid but transudate within the cavity. What does this mean, and is it concerning? Is the abnormal mass present in the uterus or the ovaries?
Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
The mass is most likely from the ovaries, and the uterus appears normal. Regarding the fallopian tubes, it is impossible to comment if it is spread from ovaries or a primary pathology with just an ultrasound. A further investigation, like CT (computed tomography) scan, is needed for diagnosis. Regarding the transudate in the uterine cavity, it just means some fluid collection inside the uterus near the lining, which can occur in cases of adnexal inflammation. Not having free fluid in the abdomen is a reassuring sign as it rules out the spread to the peritoneum.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
Can you please explain what you mean by "rules out spread"?
Thank you.
Hello,
Welcome back to icliniq.com.
Free fluid in the abdomen (ascites) generally indicates spread to the peritoneum, the lining of the abdominal cavity. It is generally the first spread in most cases but not always. So the absence of free fluid is reassuring in ruling the outspread to the peritoneum. I hope that clarifies my sentence earlier.
You can consult back after doing the blood tests.
Thank you.
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Obstetrics and Gynecology
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