Adnexal masses found in the female pelvis are perhaps one of the trickiest abnormalities to diagnose. These masses are typically found in the ovaries and have a wide range of causes and characteristics. Because of this, it is extremely important to pay close attention to their slight differences in order to begin proper treatment. In the end, only a skilled sonographer with years of experience will be able to tell the difference and properly describe different types of adnexal masses so that the doctor can properly manage the patient.
One of the most important factors when determining what type of adnexal mass a patient has developed, is studying and becoming familiar with recurring patterns. In women younger than 20 years of age, the most common adnexal masses are malignant ovarian neoplasms, malignant germ cell tumors and granulosa cell tumors. By age 40, the most common are malignant ovarian neoplasm of epithelial origin. It has been noted that the most predictive elements for assessing the risk of malignancy in an ovarian mass are age, presence of solid elements and the presence of central arterial flow in these solid elements.
Other important factors to consider when evaluating ovarian lesions are the appearance of wall structure (thickness, internal and/or external papillae), internal echo structure (sonolucent, echogenic, low level echoes or mixed echogenicity), shadowing, blood vessels and many more. All of these are crucial skill sets you want to make sure your sonographer possesses in order to offer your patients high-quality care.
Because there are so many different types of adnexal masses that can appear in the ovaries or female pelvis, they can easily be misinterpreted by an inexperienced sonographer. Therefore, at Soundwaves, we would like to offer you, not only our highly trained sonographers, but also, our rich foundation of knowledge acquired through years of working in the industry. At Soundwaves, we make sure our staff attends ultrasound conferences and discussion panels all year round, in order stay up to date with the latest in sonographic findings. We pride ourselves in setting a standard in our industry and you should too. Find out more about Soundwaves by visiting SoundwavesImage.com.
In order to achieve the most accurate results, there are a few ultrasound studies that are best scheduled within a certain time frame. Namely, these studies are: sonohysterograms, studies performed for evaluation of the endometrium, nuchal translucency, and anatomy studies.
The best time to evaluate the endometrium for possible polyp, fibroid invasion, irregularity of the endometrium, or to get an accurate measurement when determining endometrial thickness, is between days 7 and 10 of the menstrual cycle. This is also very important when performing a sonohysterogram to avoid a false positive result. If your patient is spotting between periods or having abnormal bleeding, accurate evaluation of the endometrium and the timing of the evaluation are very important.
The guidelines given by the NTQR state that nuchal translucency (NT) ultrasound is to be performed between 11 weeks and 13 weeks 6 days. The objective is to balance early detection of a problem with the ability to see the baby well enough. Performing an NT ultrasound between 12 ½ and 13 ½ weeks will help allow for accurate evaluation. Sometimes, when performed earlier, it is difficult to clearly evaluate the NT due to the size of the baby.
With anatomy scans, we face the same issue. We want to detect abnormalities as early as possible, however, we also want to be able to see small structures well enough to clearly evaluate them. When we are looking at small structures such as the chambers of the heart, it is important that that we have the clearest view possible. Performing anatomy scans close to the 19-20th week rather than week 16 may help one evaluate these smaller structures.
I have been in the field of ultrasound for 25 years and I am able to advise your office on many ultrasound related subjects. Feel free to contact me for advice on how to make sure your ultrasound practice is of the highest accuracy and quality.
Denise Barbato RDMS
Fibroids and Adenomyosis are two extremely common conditions in women, however, adenomyosis is often mistaken for fibroids by ultrasound. Adenomyosis is a severely underdiagnosed condition that is commonly mistaken for Fibroids because of its similarities in sonographic appearance and symptoms. In order to avoid mixing them up, it is important to fully understand the sonographic difference between the two.
The treatment is different for these two conditions, therefore an experienced sonographer who can tell the difference between the two is crucial. So what are some of the most common characteristics that lead to this confusion? The main sonographic finding for Adenomyosis is an asymmetrical thickening of the myometrium and an increased echogenicity due to the invasion of endometrial cells. This is often accompanied by small cysts, which create a very inhomogeneous texture. This inhomogeneous texture may resemble ill defined fibroids, and an inexperienced sonographer may confuse the two. Fibroids, on the other hand, usually appear as well-defined masses that may protrude into the endometrium or outside the uterus. They seldom have cysts and are usually more hypoechoic. Other notable differences between Fibroids and Adenomyosis are that fibroids display peripheral vessels, distal shadowing, and calcification, whereas Adenomyosis, has central vessels, streaky shadows, and no calcification. Failure to properly diagnose either of these conditions can lead to the persistence of symptoms and possibly unnecessary surgery.
Soundwaves is a turn-key ultrasound service that specializes in Ob/Gyn sonography, made up of an experienced staff that studies cases like this on a daily basis. Allow us to help you perfect your practice and assure that you are providing your patients nothing but accurate and quality care. Call us today to book a Soundwaves sonographer at your office.