Adnexal Mass in Pregnancy



Adnexal Mass in Pregnancy


Karen Y. Oh, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Corpus Luteum Cyst


  • Teratoma


  • Theca Lutein Cysts


Less Common



  • Other Ovarian Masses



    • Endometrioma


    • Cystadenoma


    • Epithelial Ovarian Carcinoma


    • Sex-Cord Stromal Tumor


  • Non-Ovarian Adnexal Masses



    • Paraovarian Cyst


    • Pedunculated Fibroid


    • Ectopic Pregnancy


    • Hydrosalpinx


    • Abscess


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Adnexa should be routinely evaluated during pregnancy



    • Usually with transvaginal ultrasound in the first trimester


    • Identify and characterize ovaries



      • If not visible in pelvis, use transabdominal approach


      • Ovary can be displaced by large associated mass or torsion


    • If mass present, characterize as ovarian versus paraovarian in location


  • Ovarian mass



    • Cystic ovarian mass usually related to corpus luteum



      • Most often simple cyst of varying sizes


      • Can be complicated or even solid-appearing


      • If large, consider close follow-up and postpartum ultrasound to exclude benign ovarian tumor


    • Solid ovarian mass most often a dermoid



      • Should have classic appearance


      • May be bilateral


    • If ovarian mass is suspicious with cystic and solid components, consider removal during pregnancy


  • Paraovarian cysts will not change over time and may have been seen on prior pelvic ultrasounds


  • If in the right lower quadrant, assess for appendicitis/appendiceal abscess


  • Adnexal mass in 1st trimester



    • Could this be an ectopic or heterotopic pregnancy?


    • Correlate with any history of in vitro fertilization or reproductive assistance


Helpful Clues for Common Diagnoses



  • Corpus Luteum Cyst



    • May be anechoic or hemorrhagic



      • Commonly complicated by hemorrhage


    • Can have thick, vascular, hyperechoic cyst wall



      • May be mistaken for ectopic gestational sac with decidual reaction


      • Ovarian ectopic pregnancy is exceedingly rare


    • Should decrease in size over pregnancy



      • Some functional cysts may persist


    • Can follow expectantly if no malignant features



      • Postpartum pelvic ultrasound to exclude benign ovarian neoplasm


      • Check for any prior pelvic ultrasounds to see if present before pregnancy


  • Teratoma



    • Most common incidental ovarian mass seen in pregnancy



      • 10% bilateral


    • May see hair, teeth, osseous structures which gives characteristic complex sonographic appearance


    • Dermoid plug often present



      • Echogenic keratin “plug”


      • Posterior acoustic shadowing


    • If large, risk of ovarian torsion


  • Theca Lutein Cysts



    • Multiple cysts within enlarged ovaries bilaterally



      • May see typical “spoke-wheel” appearance


      • Occasionally unilateral


    • Reaction of ovaries to elevated hormone levels



      • Multiple gestation pregnancies


      • Assisted reproduction patients


      • Rarely singleton pregnancy with underlying high level of beta hCG


    • Associated pregnancy may be abnormal



      • Molar pregnancy – partial or complete mole



      • Hydrops – skin edema, ascites, pleural effusions


      • Triploidy – multiple fetal anomalies, IUGR


    • Look for signs of hyperstimulation syndrome



      • Maternal effusions, ascites, oliguria


      • Seen in the setting of in vitro fertilization due to hormonal stimulation


      • May occur before intrauterine pregnancy identified


Helpful Clues for Less Common Diagnoses

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Aug 10, 2016 | Posted by in OBSTETRICS | Comments Off on Adnexal Mass in Pregnancy

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