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The Adnexal Mass
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Connie D. Cao, Norman G. Rosenblum
An adnexal mass is any mass in the ovary or tube or attached to them (adnexa). There is an increase in the detection of asymptomatic adnexal masses in pregnancy due to the increase in prenatal ultrasounds. The vast majority (>90%) of adnexal masses in pregnancy are ovarian. Most are benign simple cysts under 5 cm. The diagnosis is most accurately made by ultrasound, even if it is possible to diagnose an adnexal mass by bimanual physical exam. A persistent adnexal mass is one that does not resolve by the second trimester.
Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Pain is almost always the presenting symptom, but the nature of the pain is highly variable. The onset may be sudden or gradual. The character may be sharp and intermittent, or dull and constant. In about two-thirds of cases, the pain is unilateral in the lower abdomen. It may be generalized or, uncommonly, it may radiate to the back or flank. Nausea and/or vomiting are present in about half of the patients. Various urinary symptoms are less often reported (91,92). Abdominal tenderness is the most constant physical finding. Peritoneal signs are variably present. There may be adnexal tenderness or a mass. Leukocytosis may be present, but a normal white blood cell count does not rule out the diagnosis. Ultrasonographic imaging may aid in the identification and characterization of an adnexal mass. Color Doppler sonography may show absent arterial flow in the central ovarian parenchyma. Absent central ovarian venous flow may be a more sensitive finding in cases of adnexal torsion (93). Comparison with the uninvolved contralateral ovary may aid in sonographic diagnosis. Given the nonspecific clinical presentation, it is not surprising that the preoperative diagnosis is often erroneous (90,91).
Ovarian cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Stephanie Nougaret, Helen Addley, Evis Sala, Anju Sahdev
Adnexal masses are a common clinical problem, with an estimated 5%–10% of women undergoing surgery for a suspected adnexal mass, but in only 13%–21% of these women will the mass prove to be malignant (68). Transvaginal ultrasound (TVUS) is traditionally the first-line imaging modality for evaluating a suspected or palpable pelvic mass as it is readily available, cheap, and carries no radiation burden. In this context, the aim of US is to: Confirm the origin of the massIdentify features suggestive of malignancyIdentify features suggestive of a benign lesion
The investigation of T-cell receptor subtypes in ovarian cancer: effects on survival and prognostic factors
Published in Journal of Obstetrics and Gynaecology, 2021
Sultan Özkan, Nur Selvi Gunel, Duygu Aygünes, Levent Akman, Nuri Yildirim, Aslı Teti̇k Vardarli, Aydın Özsaran, Coşan Terek
This study included 47 patients with the diagnosis of adnexal mass who were admitted to The Department of Obstetrics and Gynecology, Ege University Hospital between March 2011 and November 2012. After the preoperative work-up including physical examination, abdominal ultrasonography, chest X-ray and blood chemistry, they were scheduled for surgery. After the operation, they were divided into two groups according to their pathology as being benign or malignant. Twenty-four of them were malignant and 23 of them were benign cases. The exclusion criteria were the borderline tumours and the patients who underwent neoadjuvant chemotherapy. The study was approved by The Ethics Committee of Clinical Research in Ege University (February 23 2011; 10-11.1/55). All patients signed informed consent after explaining the study and the trial was conducted in accordance with the Helsinki II Declaration.
Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management
Published in Journal of Obstetrics and Gynaecology, 2019
Padmasree Resapu, Sirisha Rao Gundabattula, Vijaya Bharathi Bayyarapu, Manjula Pochiraju, Kameswari Surampudi, Shashikala Dasari
This was a retrospective study of women with abdominal pain who either underwent surgery for suspected adnexal torsion or were found to have torsion intraoperatively. Women with the ultrasound features of torsion but which was not confirmed by surgery and the asymptomatic patients with incidental operative finding of torsion during surgery performed for other reasons were excluded. Preoperatively, adnexal torsion was diagnosed based on clinical suspicion with or without sonographic concordance. Classically, this presents as acute-onset abdominal pain, nausea and vomiting with or without an adnexal mass. The sonographic features suggestive of torsion include: enlarged, oedematous and displaced ovary, ovarian mass (sometimes tender), multiple small peripheral follicles, hyperechoic rings around the antral follicles (follicular rings), decreased or no blood supply to the ovary and whirlpool sign in the ovarian vessels (Sibal 2012; Laufer 2015).
Chronic tubal ectopic pregnancy following clinically successful methotrexate treatment for an acute ectopic: a review of the literature
Published in Journal of Obstetrics and Gynaecology, 2019
Lorraine Sheena Kasaven, Abhijeet Shah, Sadoon Sadoon
In review of the literature, we can deduce that CEP is a pre-diagnostically challenging paradox. The diagnosis is confirmed by the histological findings following a laparoscopy. Evaluation of the retrospective studies highlights the salient pre-diagnostic symptoms as the presence of pelvic pain, abnormal vaginal bleeding and amenorrhoea. A negative β-hCG does not exclude CEP. Ultrasound findings are often that of an adnexal mass. In addition, adhesions or a tubal mass are common findings during a laparoscopy. Increasing the awareness of the clinical and diagnostic features of CEP should remind clinicians to have a high index of suspicion to make a timely diagnosis.