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What Does Abdominal And Intravaginal Ultrasound Report Indicate?
Question: I have attached my abdominal ultrasound, intravaginal ultrasound and my CT with IV contrast. I am a 37yr old female. I had severe sudden onset upper right quad abdominal pain April2. ER gave donnatol and sent home. Pain persisted so went to primary care and her Ultrasound showed small amount ascites around liver, morrisons pouch and pelvic cul de sac. Sent back to ER. Transvaginal US showed a 3cm complex cystic structure, on right ovary with with moderate free fluid. Also several simple cysts present on rt ovary. Rt ovary measures 5.9x2.8x4.6cm. Is that normal sized or enlarged? Left ovary not visible. Small free fluid in endocervical canal. 6mm echogenic hypervascular lesion found anterior to endometrial stripe near cervix and radiologist made a point to say it did not look like a fibroid or cesarean scar mass. CT with IV contrast showed no problems with liver or other abdominal organs and blood work supported that. Theory is the ascites is from the ovaries. Does this indicate ovarian cancer or can the ascites in abdomen be from a benign ovarian cyst? When I research I can only find ascites from ovaries associated with ovarian cancer. I can't find a single case where ascites from benign ovarian cyst. So here are my pressing questions.
1. my obgyn (who still hasn't seen me) has ordered ca-125 and CEA ONLY because I asked him to. via email just looking at the same scans as you will see attached. He says he is certain this is not ovarian cancer. just a simple ruptured cyst. If I were your sister or daughter, would you order any other tests or procedures based on the three imaging studies I have provided? Would you be confident based on these radiology reports that I am cancer free?
2. If the ca-125 and CEA are normal, should I rest assured I don't have ovarian cancer?
1. my obgyn (who still hasn't seen me) has ordered ca-125 and CEA ONLY because I asked him to. via email just looking at the same scans as you will see attached. He says he is certain this is not ovarian cancer. just a simple ruptured cyst. If I were your sister or daughter, would you order any other tests or procedures based on the three imaging studies I have provided? Would you be confident based on these radiology reports that I am cancer free?
2. If the ca-125 and CEA are normal, should I rest assured I don't have ovarian cancer?
Brief Answer:
Repeat ultrasound after periods. Do serum LDH, HCG and AFP
Detailed Answer:
Hi
Welcome to Healthcare Magic. I appreciate your concerns.
I am Dr Ramadevi Wani. I will be answering your concerns today.
I first would like to tell you certain facts. In a premenopausal woman the chance of a ovarian cyst being malignant is 1 in 1000. So almost all ovarian masses in premenopausal women are benign as long as there is no family history of ovarian/ breast cancer.
The right ovary size mentioned is not normal. It is slightly enlarged. It is very clear that it is enlarged due to ovarian cyst.
The ascites in your case can be due to ruptured cyst. The pain you experienced could be due to cyst rupture. Please note that the ascites can also be due to benign ovarian mass like fibroma or cystadenoma. Rarely as you have mentioned it can be due to ovarian cancer.
When are you expecting your period? I would repeat the ultrasound after the mensus. That would give a clear picture. If the multilocular cysts mentioned are follicles they would appear smaller. The possibility of complex mass being ruptured corpus luteal cyst would be verified.
I have gone through the attached reports. The ultrasound findings are not suggestive of malignancy. In addition to CA 125, I would also advise you to do HCG, LDH and AFP levels considering the possibility of germ cell tumours being common in this age group.
IF the blood tests I mentioned including CA 125 are normal, it almost rules out cancer. But one cannot be 100% sure. If this complex mass is persistent despite normal hormone results, then I advise you to undergo laparoscopic excision of the mass/ovary .
I hope I have answered your concerns.
If you have any further queries, do write to me. i will be happy to answer.
Repeat ultrasound after periods. Do serum LDH, HCG and AFP
Detailed Answer:
Hi
Welcome to Healthcare Magic. I appreciate your concerns.
I am Dr Ramadevi Wani. I will be answering your concerns today.
I first would like to tell you certain facts. In a premenopausal woman the chance of a ovarian cyst being malignant is 1 in 1000. So almost all ovarian masses in premenopausal women are benign as long as there is no family history of ovarian/ breast cancer.
The right ovary size mentioned is not normal. It is slightly enlarged. It is very clear that it is enlarged due to ovarian cyst.
The ascites in your case can be due to ruptured cyst. The pain you experienced could be due to cyst rupture. Please note that the ascites can also be due to benign ovarian mass like fibroma or cystadenoma. Rarely as you have mentioned it can be due to ovarian cancer.
When are you expecting your period? I would repeat the ultrasound after the mensus. That would give a clear picture. If the multilocular cysts mentioned are follicles they would appear smaller. The possibility of complex mass being ruptured corpus luteal cyst would be verified.
I have gone through the attached reports. The ultrasound findings are not suggestive of malignancy. In addition to CA 125, I would also advise you to do HCG, LDH and AFP levels considering the possibility of germ cell tumours being common in this age group.
IF the blood tests I mentioned including CA 125 are normal, it almost rules out cancer. But one cannot be 100% sure. If this complex mass is persistent despite normal hormone results, then I advise you to undergo laparoscopic excision of the mass/ovary .
I hope I have answered your concerns.
If you have any further queries, do write to me. i will be happy to answer.
Above answer was peer-reviewed by :
Dr. Raju A.T
My next cycle starts in about 14 days, however the scans were taken on about day 10 of my cyle ( I was spotting during scans) and I normally bleed from day 1-14 roughly. Days 1-5 are heavy, painful flow and days 6-14 are medium to mild spotting(red to brown/black towards end) It is hard for me to say when my cycle is really over. So if I understand correctly, you are suggesting repeat ultrasound on day 15-28 sometime before new bleeding starts again?
Also, do you agree from the small amount of ascites described in my radiology reports that it would not be possible to do a needle aspiration of the ascites? I was told by ER doctor the only way to test the fluid was open surgery. You can see the same reports he saw. would you try a needle aspiration on me?
I have a history of rare tumors with catastrophic results that have left me traumatized. I feel like I want the cysts and uterine lesion removed asap. Would most gynecological oncologist agree to this or do you think they will make me do less invasive treatments first?
Also, do you agree from the small amount of ascites described in my radiology reports that it would not be possible to do a needle aspiration of the ascites? I was told by ER doctor the only way to test the fluid was open surgery. You can see the same reports he saw. would you try a needle aspiration on me?
I have a history of rare tumors with catastrophic results that have left me traumatized. I feel like I want the cysts and uterine lesion removed asap. Would most gynecological oncologist agree to this or do you think they will make me do less invasive treatments first?
Brief Answer:
Wait for the results of blood test.
Detailed Answer:
Hi,
Welcome back.
No I was suggesting you to do the ultrasound immediately after the heavy bleeding of your new period ( day 6/7 of your cycle) and not before the period.
I thought may be this ultrasound is taken in the latter half of your menstrual cycle. So I asked you to repeat it. Since the present ultrasound is done on day 10 there may not be any difference in the two ultrasounds. Yet I recommend that ultrasound be repeated on day 6/7.
I have noted all the surgeries that you have had. I empathize with you.
But if you were my patient in my clinic,
- I would wait for the results of blood tests and repeat the ultrasound after your new period (Day 6/7).
-I would take hysteroscopic guided endometrial sampling from that vascular lesion in the endometrium. I don't think it is anything serious. It could just be a benign polyp. I presume all your pap smear results so far have been normal.
-If the blood test results /histopathology of endometrial echogenic stripe results are abnormal, I would refer you to Gyneoncologist.
- If the blood tests are normal but the ovarian mass persists, I would do laparoscopic removal of the ovary along ascetic fluid aspiration for cytology.
I believe most gyneoncologists would agree with my plan of management.
Ultrasound guided aspiration of ascetic fluid can be done too ( answer to your question).
I hope this helps.
If you have any further questions, do write to me.
Do keep me updated with your blood test results.
My best wishes to you.
Wait for the results of blood test.
Detailed Answer:
Hi,
Welcome back.
No I was suggesting you to do the ultrasound immediately after the heavy bleeding of your new period ( day 6/7 of your cycle) and not before the period.
I thought may be this ultrasound is taken in the latter half of your menstrual cycle. So I asked you to repeat it. Since the present ultrasound is done on day 10 there may not be any difference in the two ultrasounds. Yet I recommend that ultrasound be repeated on day 6/7.
I have noted all the surgeries that you have had. I empathize with you.
But if you were my patient in my clinic,
- I would wait for the results of blood tests and repeat the ultrasound after your new period (Day 6/7).
-I would take hysteroscopic guided endometrial sampling from that vascular lesion in the endometrium. I don't think it is anything serious. It could just be a benign polyp. I presume all your pap smear results so far have been normal.
-If the blood test results /histopathology of endometrial echogenic stripe results are abnormal, I would refer you to Gyneoncologist.
- If the blood tests are normal but the ovarian mass persists, I would do laparoscopic removal of the ovary along ascetic fluid aspiration for cytology.
I believe most gyneoncologists would agree with my plan of management.
Ultrasound guided aspiration of ascetic fluid can be done too ( answer to your question).
I hope this helps.
If you have any further questions, do write to me.
Do keep me updated with your blood test results.
My best wishes to you.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
I saw my obgyn. based on the same reports you see he said there is nothing at all to worry about and he has no plans to follow up or do any other imaging studies. my ca-125 was 29.8 and CEA was .5
He said it was a normal ovulation where a drop or two of blood escaped into abdomen causing pain. he said uterine lesion was a polyp and those are never cancerous. he said its not possible for a 3cm ovarian complex cyst to cause ascites and he thinks i don't have ascitesm, even though 3 reports say I do. He said it is the normal moisture that comes of the organs, like sweat. He did not do a pelvic or even touch me. He has no follow up planned. He will not give referral to gyno/oncology.
I don't know what to do. He is head of OB/gyn department at my medical group.
what do you suggest?
He said it was a normal ovulation where a drop or two of blood escaped into abdomen causing pain. he said uterine lesion was a polyp and those are never cancerous. he said its not possible for a 3cm ovarian complex cyst to cause ascites and he thinks i don't have ascitesm, even though 3 reports say I do. He said it is the normal moisture that comes of the organs, like sweat. He did not do a pelvic or even touch me. He has no follow up planned. He will not give referral to gyno/oncology.
I don't know what to do. He is head of OB/gyn department at my medical group.
what do you suggest?
Brief Answer:
Repeat ultrasound after heavy flow of your periods.
Detailed Answer:
Hi XXXX,
Welcome back.
I am very happy to know that tumour marker levels are normal. So as I mentioned before most probably the pain and the fluid in the abdomen could be as a result of follicular cyst rupture ( Ovulation is unlikely to happen on 10th day of period).
Now stop worrying. Repeat ultrasound after heavy flow of your periods (6/7th day) to make sure that the ruptured cyst structure is resolved/ reduced in size. If it is still present then you need to do other tumour markers, which I have mentioned before. If the uterus shows that polyp like structure, I recommend that you undergo office hysteroscopy and polypectomy (removal of the polyp). That could be the reason for the prolonged bleeding you are experiencing during your periods.
Keep me updated about the ultrasound findings.
If you have any further queries, do contact me through Healthcare Magic.
Repeat ultrasound after heavy flow of your periods.
Detailed Answer:
Hi XXXX,
Welcome back.
I am very happy to know that tumour marker levels are normal. So as I mentioned before most probably the pain and the fluid in the abdomen could be as a result of follicular cyst rupture ( Ovulation is unlikely to happen on 10th day of period).
Now stop worrying. Repeat ultrasound after heavy flow of your periods (6/7th day) to make sure that the ruptured cyst structure is resolved/ reduced in size. If it is still present then you need to do other tumour markers, which I have mentioned before. If the uterus shows that polyp like structure, I recommend that you undergo office hysteroscopy and polypectomy (removal of the polyp). That could be the reason for the prolonged bleeding you are experiencing during your periods.
Keep me updated about the ultrasound findings.
If you have any further queries, do contact me through Healthcare Magic.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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