Complex Adnexal Masses

Hemorrhagic ovarian cysts have a variable appearance but are often difficult to differentiate sonographically from endometriomas, tuboovarian abscesses, benign ovarian tumors, or malignancies (Fig 109-2.4). Dermoids appear sonographically as focal bright echoes in a complex adnexal mass. In general, septated, complex, irregular, and hyperechoic adnexal masses are more commonly malignant and require further investigation. The combination of a large, complex adnexal mass and ascites makes the likelihood of ovarian carcinoma very high.

FIG. 109-24. Complex mass. This adnexal mass (plus signs mark borders) has multiple hypoechoic and hyperechoic regions. This could represent a tubo-ovarian abscess, ectopic pregnancy, hemorrhagic ovarian cyst, or ovarian tumor.

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