6. RANDOM OVARIAN PATH

Question 1

The most constant finding in ovarian torsion

Answer 1

Large ovary

Question 2

Features of Ovarian Torsion

Answer 2

Unilateral enlarged ovary (> 4 cm)
Mass on the ovary
Peripheral cysts +/- fluid-debris level
Free fluid
Lack of arterial/venous flow

Question 3

How does the ovary differ from the testicle?

Answer 3

OVary = dual blood supply

Just because you have flow, does NOT mean there isn’t a torsion.

Question 4

Big ovary + pain =

Answer 4

Torsion

Question 5

Answer 5

Hydrosalpinx

“string sign” - inclomplete septae

Thin (or thick in chronic states) elongated tubular structure in the pelvis.

Question 6

Answer 6

Hydrosalpinx

“Cogwheel appearance”

normal longitudinal folds of a fallopian tube becoming thickened

Question 7

this is suppose to help differentiate hydrosalpinx from an ovarian mass

Answer 7

“Waist sign”

“tubular mass with indentations of its opposing walls “

Question 8

Causes of hydrosalpinx

Answer 8

skank, infidel, or free spirit = PID

Endometriosis, tubal cancer, post hysterectomy (without salpingectomy / oophorectomy), and tubal ligation.

Question 9

Infection or inflammation of the upper female genital tract.

Answer 9

Pelvic Inflammator Disease

Question 10

Answer 10

Pelvic Inflammator Disease

“Indefinite uterus”

Question 11

This is a congenital remnant that arises from the Wolffian duct.

Answer 11

PAraovarian cyst

Question 12

Answer 12

PAraovarian cyst

Round ovarian cyst that “do NOT distort the adjacent ovary”

Question 13

Answer 13

OVarian vein thrombosis

a tubular structure with an enhancing wall and low-attenuation thrombus (arrow) in the expected location of the ovarian vein.

Question 14

Ovarian Vein Thrombophlebitis are commonly seen in what population?

Answer 14

Postpartum women

Question 15

Acute pelvic pain + fever + 10 days post delivery

Answer 15

Ovarian Vein Thrombophlebitis

Question 16

Where is Ovarian Vein Thrombophlebitis usually located?

Answer 16

80% of the time it’s on the right.

Question 17

Dreaded sequela of Ovarian Vein Thrombophlebitis

Answer 17

Pulmonary embolus

Tx - anticoagulation,

Question 18

Peritoneal Inclusion Cyst occurs when?

Answer 18

Adhesions envelop an ovary

Question 19

Answer 19

Peritoneal Inclusion Cyst

“Adhesions around an Ovary”

“Passive shape” that conforms to and is defined by surrounding structures.

Question 20

A woman of reproductive age + Hx endometriosis + Pelvic surgery and PID

+ fluid filled mass = surrounds ovary + conforms to the shape of the pelvis

Answer 20

Peritoneal inclusion cyst

Question 21

Most common form of Gestational Trophoblastic Disease

Answer 21

Hydatidiform Mole

Question 22

Two subtypes of Hydatidiform Mole

Answer 22

1. Complete (70%)
2. Partial

Question 23

This type of H-Mole involves the entire placenta.

Answer 23

Complete

Question 24

Answer 24

Complete Hydatidiform Mole

“snowstorm” appearance in the first trimester

uterus to be filled with an echogenic, solid, highly vascular mass,

Question 25

Answer 25

Complete Hydatidiform Mole "bunch of grapes" appearance in the 2nd trimester uterus to be filled with an echogenic, solid, highly vascular mass,

Question 26

H-mole + portion of the placenta + jacked up fetus (triploid in karyotype) = lethat to the fetus

Answer 26

Partial H-mole

Question 27

fertilizationofanovumbytwo sperm (69XXY)

Answer 27

Partial H-mole

Question 28

Answer 28

Parial Hydatidiform mole

Question 29

What cysts are seen in molar pregnancies?

Answer 29

Theca lutein cysts Most commonly bilateral in the 2nd trimetster

Question 30

When can you see an invasive mole?

Answer 30

After treatment of H-mole (10%)

Question 31

Answer 31

Invasive mole focal myometrial masses, dilated vessels, and areas of hemorrhage and necrosis.

Question 32

This is a very aggressive malignancy that forms only trophoblasts (no villous structure).

Answer 32

Choriocarcinoma

Question 33

How does Choriocarcinoma spread?

Answer 33

locally into myometrium + parametrium = spread hematogeneous to ANY site

Question 34

Evacuation of molar pregnancy + Inc B-HCG in 8-10 weeks

Answer 34

Choriocarcinoma

Question 35

Answer 35

Choriocarcinoma a highly echogenic solid mass. Tx = methotrexate