The ovaries can usually be found lateral to the body of the uterus, anterior to the internal iliac vessels, and anteromedial to the external iliac vessels ( Fig 109-6 and

Fig 109-7.). There is variability in the position of the ovaries in women who have been pregnant. The distended bladder, which is required for transabdominal imaging of the ovaries, may displace them more cephalad. The size of each ovary is about 2 by 2 by 3 cm, although this may vary widely. Each ovary contains several small hypoechoic cysts, which are the maturing follicles. The sonographic appearance of the ovary changes throughout the menstrual cycle as several follicles are recruited and then a dominant follicle emerges, followed by the development of a corpus luteum.

FIG. 109-6. Anatomy of pelvis. This drawing shows the normal anatomic relationship between the ovary and the iliac vessels, with the iliac vessels drawn in longitudinal section. See Fig 109-7,.

FIG. 109-7. Ovarian cyst. Sonographic image of the structures drawn in Fig 109-6. A large cyst is visualized in the left ovary (plus signs mark borders). This demonstrates the normal position of the ovary in relation to the iliac vessels.

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