PATHOLOGY	ETIOLOGY	CLINICAL FINDINGS	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Endometriosis	Ectopic location of functional endometrial tissue Attaches to the fallopian tubes, ovaries, colon, and bladder	Asymptomatic Dysmenorrhea Pelvic pain Irregular menses Dyspareunia Infertility	Difficult to visualize with sonography Obscure organ boundaries Fixation of the ovaries posterior to the uterus Endometrioma	Adhesions Bowel interference
Endometrioma	Focal collection of ectopic endometrial tissue Termed “chocolate cyst”	Pelvic pain Metromenorrhagia Dysmenorrhea Dyspareunia Palpable pelvic mass Infertility	Hypoechoic, homogeneous adnexal mass Thick, well-defined wall margins Diffuse, low-level echoes with or without solid components Avascular mass Fluid/Fluid level Mass will not regress in size on serial sonograms	Hemorrhagic cyst Pedunculated fibroid Cystic teratoma
Krukenberg tumors	Metastatic lesions Primary lesion from gastric carcinoma Other primary structures may include large intestines, breast, or appendix	Asymptomatic Abdominal pain Bloating	Bilateral adnexal or ovarian masses Oval or lobulated margins Hypoechoic areas within the mass Posterior enhancement Ascites Generally bilateral	Ovarian carcinoma Degenerating fibroid Tuboovarian abscess Cystic teratoma Endometrioma
Parovarian cyst	Mesothelial in origin Typically located in the broad ligament Not associated with a history of pelvic inflammation, surgery, or endometriosis	Asymptomatic Pelvic pain Palpable pelvic mass	Round or ovoid anechoic adnexal mass Separate from ipsilateral ovary Thin, smooth wall margins Stable size on serial sonograms	Cystadenoma Hydrosalpinx Ovarian cyst Meckel diverticulum Peritoneal cyst
Pelvic inflammatory disease	Bacterial infection Diverticulitis Appendicitis	Abdominal pain Fever Vaginal discharge Urinary frequency	Normal pelvic appearance Thick and hypervascular endometrium Complex tubular adnexal mass Ill-defined multilocular adnexal mass	Normal pelvis Loops of bowel Endometriosis Ectopic pregnancy
Peritoneal inclusion cyst	Adhesions trap fluid normally produced by the ovary Previous abdominal surgery Trauma Pelvic inflammatory disease Endometriosis	Asymptomatic Lower abdominal pain Palpable mass	Septated fluid collection surrounding an ovary Vascular flow can be demonstrated in septae Unilocular peritoneal cyst	Ascites Parovarian cyst Hydrosalpinx

Pathology of the Fallopian Tubes

PATHOLOGY	ETIOLOGY	CLINICAL FINDINGS	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Carcinoma	Dysplasia Carcinoma in situ	Pelvic pain Abnormal bleeding Pelvic mass	Sausage-shaped complex adnexal mass Papillary projections	Tuboovarian abscess Loops of bowel
Hydrosalpinx	Pelvic inflammatory disease Endometriosis Postoperative adhesions	Asymptomatic Pelvic fullness Infertility	Anechoic tubular adnexal mass Thin wall margins Absence of peristalsis	Fluid-filled loop of bowel Dilated ureter External iliac vein Ovarian cyst Omental cyst
Pyosalpinx	Bacterial infection Diverticulitis Appendicitis	Asymptomatic Low-grade fever Pelvic fullness	Complex tubular adnexal mass Wall thickness ≥5 mm Irregular wall margins Mass attenuates the sound	Bowel loops Ovarian neoplasm Iliac vessel Hydroureter
Salpingitis	Pelvic infection	Pelvic pain Fever Dyspareunia Leukocytosis	Nodular, thick tubular adnexal mass Complex adnexal mass Posterior enhancement	Loops of bowel Endometriosis
Tuboovarian abscess	Pelvic infection Sexually transmitted disease	Severe pelvic pain Fever Leukocytosis Nausea/Vomiting	Complex multilocular adnexal mass Ill-defined wall margins Total breakdown of the normal adnexal anatomy	Endometriosis Ectopic pregnancy Hemorrhagic cyst