PATHOLOGY	ETIOLOGY	CLINICAL FINDINGS	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Endometriosis	Ectopic location of functional endometrial tissueAttaches to the fallopian tubes, ovaries, colon, and bladder	AsymptomaticDysmenorrheaPelvic painIrregular mensesDyspareuniaInfertility	Difficult to visualize with sonographyObscure organ boundariesFixation of the ovaries posterior to the uterusEndometrioma	AdhesionsBowel interference
Endometrioma	Focal collection of ectopic endometrial tissueTermed “chocolate cyst”	Pelvic painMetromenorrhagiaDysmenorrheaDyspareuniaPalpable pelvic massInfertility	Hypoechoic, homogeneous adnexal massThick, well-defined wall marginsDiffuse, low-level echoes with or without solid componentsAvascular massFluid/Fluid levelMass will not regress in size on serial sonograms	Hemorrhagic cystPedunculated fibroidCystic teratoma
Krukenberg tumors	Metastatic lesionsPrimary lesion from gastric carcinomaOther primary structures may include large intestines, breast, or appendix	AsymptomaticAbdominal painBloating	Bilateral adnexal or ovarian massesOval or lobulated marginsHypoechoic areas within the massPosterior enhancementAscitesGenerally bilateral	Ovarian carcinomaDegenerating fibroidTuboovarian abscessCystic teratomaEndometrioma
Parovarian cyst	Mesothelial in originTypically located in the broad ligamentNot associated with a history of pelvic inflammation, surgery, or endometriosis	AsymptomaticPelvic painPalpable pelvic mass	Round or ovoid anechoic adnexal massSeparate from ipsilateral ovaryThin, smooth wall marginsStable size on serial sonograms	CystadenomaHydrosalpinxOvarian cystMeckel diverticulumPeritoneal cyst
Pelvic inflammatory disease	Bacterial infectionDiverticulitisAppendicitis	Abdominal painFeverVaginal dischargeUrinary frequency	Normal pelvic appearanceThick and hypervascular endometriumComplex tubular adnexal massIll-defined multilocular adnexal mass	Normal pelvisLoops of bowelEndometriosisEctopic pregnancy
Peritoneal inclusion cyst	Adhesions trap fluid normally produced by the ovaryPrevious abdominal surgeryTraumaPelvic inflammatory diseaseEndometriosis	AsymptomaticLower abdominal painPalpable mass	Septated fluid collection surrounding an ovaryVascular flow can be demonstrated in septaeUnilocular peritoneal cyst	AscitesParovarian cystHydrosalpinx

Pathology of the Fallopian Tubes

PATHOLOGY	ETIOLOGY	CLINICAL FINDINGS	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Carcinoma	DysplasiaCarcinoma in situ	Pelvic painAbnormal bleedingPelvic mass	Sausage-shaped complex adnexal massPapillary projections	Tuboovarian abscessLoops of bowel
Hydrosalpinx	Pelvic inflammatory diseaseEndometriosisPostoperative adhesions	AsymptomaticPelvic fullnessInfertility	Anechoic tubular adnexal massThin wall marginsAbsence of peristalsis	Fluid-filled loop of bowelDilated ureterExternal iliac veinOvarian cystOmental cyst
Pyosalpinx	Bacterial infectionDiverticulitisAppendicitis	AsymptomaticLow-grade feverPelvic fullness	Complex tubular adnexal massWall thickness ≥5 mmIrregular wall marginsMass attenuates the sound	Bowel loopsOvarian neoplasmIliac vesselHydroureter
Salpingitis	Pelvic infection	Pelvic painFeverDyspareuniaLeukocytosis	Nodular, thick tubular adnexal massComplex adnexal massPosterior enhancement	Loops of bowelEndometriosis
Tuboovarian abscess	Pelvic infectionSexually transmitted disease	Severe pelvic painFeverLeukocytosisNausea/Vomiting	Complex multilocular adnexal massIll-defined wall marginsTotal breakdown of the normal adnexal anatomy	EndometriosisEctopic pregnancyHemorrhagic cyst