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Shibuki S, Saida T, Hoshiai S, Ishiguro T, Sakai M, Amano T, Abe T, Yoshida M, Mori K, Nakajima T. Imaging findings in inflammatory disease of the genital organs. Jpn J Radiol 2024; 42:331-346. [PMID: 38165529 PMCID: PMC10980613 DOI: 10.1007/s11604-023-01518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.
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Affiliation(s)
- Saki Shibuki
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tsukasa Saida
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sodai Hoshiai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toshitaka Ishiguro
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masafumi Sakai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Taishi Amano
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tetsuya Abe
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Miki Yoshida
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kensaku Mori
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahito Nakajima
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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2
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Ovarian fibromatosis: “The black garland sign”. RADIOLOGIA 2022; 64:164-168. [DOI: 10.1016/j.rxeng.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
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3
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Onder O, Karaosmanoglu AD, Kraeft J, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Hahn PF. Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms. Insights Imaging 2021; 12:95. [PMID: 34232414 PMCID: PMC8263845 DOI: 10.1186/s13244-021-01046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Tumors of the genital system are common and imaging is of crucial importance for their detection and diagnosis. Several non-neoplastic diseases may mimic these tumors and differential diagnosis may be difficult in certain cases. Misdiagnosing non-neoplastic diseases as tumor may prompt unnecessary medical treatment or surgical interventions. In this article, we aimed to present the imaging characteristics of non-neoplastic diseases of the male and female genital systems that may mimic neoplastic processes. Increasing awareness of the imaging specialists to these entities may have a severe positive impact on the management of these patients.
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Affiliation(s)
- Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | | | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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4
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Radu MR, Prădatu A, Duică F, Micu R, Creţoiu SM, Suciu N, Creţoiu D, Varlas VN, Rădoi VE. Ovarian Cancer: Biomarkers and Targeted Therapy. Biomedicines 2021; 9:693. [PMID: 34207450 PMCID: PMC8235073 DOI: 10.3390/biomedicines9060693] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/25/2022] Open
Abstract
Ovarian cancer is one of the most common causes of death in women as survival is highly dependent on the stage of the disease. Ovarian cancer is typically diagnosed in the late stage due to the fact that in the early phases is mostly asymptomatic. Genomic instability is one of the hallmarks of ovarian cancer. While ovarian cancer is stratified into different clinical subtypes, there still exists extensive genetic and progressive diversity within each subtype. Early detection of the disorder is one of the most important steps that facilitate a favorable prognosis and a good response to medical therapy for the patients. In targeted therapies, individual patients are treated by agents targeting the changes in tumor cells that help them grow, divide and spread. Currently, in gynecological malignancies, potential therapeutic targets include tumor-intrinsic signaling pathways, angiogenesis, homologous-recombination deficiency, hormone receptors, and immunologic factors. Ovarian cancer is usually diagnosed in the final stages, partially due to the absence of an effective screening strategy, although, over the times, numerous biomarkers have been studied and used to assess the status, progression, and efficacy of the drug therapy in this type of disorder.
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Affiliation(s)
- Mihaela Raluca Radu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania; (M.R.R.); (A.P.); (F.D.); (N.S.)
| | - Alina Prădatu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania; (M.R.R.); (A.P.); (F.D.); (N.S.)
| | - Florentina Duică
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania; (M.R.R.); (A.P.); (F.D.); (N.S.)
| | - Romeo Micu
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Sanda Maria Creţoiu
- Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Nicolae Suciu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania; (M.R.R.); (A.P.); (F.D.); (N.S.)
- Division of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Alessandrescu-Rusescu National Institute for Mother and Child Health, Polizu Clinical Hospital, 020395 Bucharest, Romania;
| | - Dragoş Creţoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania; (M.R.R.); (A.P.); (F.D.); (N.S.)
- Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 01171 Bucharest, Romania
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Viorica Elena Rădoi
- Department of Obstetrics and Gynecology, Alessandrescu-Rusescu National Institute for Mother and Child Health, Polizu Clinical Hospital, 020395 Bucharest, Romania;
- Department of Medical Genetics, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Urios MS, García Espasa C, Concepción Aramendía L. Ovarian Fibromatosis: "The black garland sign". RADIOLOGIA 2021; 64:S0033-8338(21)00015-1. [PMID: 33551120 DOI: 10.1016/j.rx.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022]
Abstract
The main objective in the imaging differential diagnosis of an ovarian mass is to establish whether it is cystic or solid; solid lesions are less common. Ovarian fibromatosis is a benign disease of the ovary that is rarely included in the differential diagnosis of solid ovarian lesions. Characteristic features of masses that have a fibrous component are low signal in T1-weighted MRI sequences and especially in T2-weighted MRI sequences. The presence of peripheral fibrotic tissue around the residual ovarian tissue is specific to ovarian fibromatosis; on MRI, this results in marked hypointensity on T2-weighted images that has been dubbed the "black garland sign". This sign, together with slight peripheral enhancement after the administration of contrast material and the preservation of the ovarian architecture, facilitates the diagnosis, making it possible to avoid unnecessary surgical interventions.
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Affiliation(s)
- M Santos Urios
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España.
| | - C García Espasa
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España
| | - L Concepción Aramendía
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España
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Devlin K, Payton A, Rubino J, Shapiro R. A Rare Case of Benign Luteomas of Pregnancy Masquerading as Malignancy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320905864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A luteoma is a benign ovarian mass that can have malignant characteristics on sonography. Pelvic sonography is used to help distinguish benign from malignant masses. The workup of adnexal masses during pregnancy may involve the use of both transabdominal and transvaginal sonography as well as Doppler imaging, magnetic resonance imaging, and serum tumor markers to identify the risk of malignancy. This study presents a case of a benign ovarian luteoma of pregnancy detected during sonography. The mass was removed during the first trimester due to malignant sonographic features. Counseling and treatment regarding ovarian masses should consist of a multidisciplinary team made up of physicians in maternal-fetal medicine, radiology, neonatology, and sonographers.
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Affiliation(s)
- Kelly Devlin
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Amber Payton
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Obstetrics & Gynecology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jessica Rubino
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Robert Shapiro
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Obstetrics & Gynecology, School of Medicine, West Virginia University, Morgantown, WV, USA
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7
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The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions. J Pediatr Surg 2018; 53:2013-2018. [PMID: 29433795 DOI: 10.1016/j.jpedsurg.2017.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The utility of magnetic resonance imaging (MRI) in the diagnosis and management of pediatric ovarian lesions has not been well defined. METHODS A retrospective review of all girls who underwent MRI evaluation of ovarian masses during the period 2009-2015 was performed. The accuracy of MRI was evaluated by comparing results with surgical findings, pathology reports, and subsequent imaging. The influence of the MRI on the treatment plan was specifically explored. RESULTS Eighteen girls, 12-17years of age, underwent 27 MRIs, subsequent to ultrasound identification of ovarian lesions. Of 9 neoplastic lesions diagnosed on MRI, 8 (89%) were confirmed by surgical and pathological findings. Of 18 functional lesions, 17 (94.4%) were confirmed pathologically or by resolution on subsequent imaging. Twenty MRI exams (74%) directly influenced the treatment plan, by leading to appropriate operative intervention in 9 and appropriate observation in 11. The extent of ovarian resection was guided by MRI findings in 8 of 9 (89%) neoplastic lesions. For characterizing lesions as neoplastic, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI were 89%, 94%, 94%, 89%, and 93% respectively. CONCLUSIONS MRI can differentiate functional from neoplastic pediatric ovarian masses, and guide ovarian resection in appropriate cases. LEVEL OF STUDY II.
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8
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Diaz A, Yarmish G, Hayim M. The black garland sign in ovarian fibromatosis. Abdom Radiol (NY) 2018; 43:1785-1786. [PMID: 29143075 DOI: 10.1007/s00261-017-1384-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Abstract
Pelvic pain is a common complaint in female patients who present to the emergency department. Although encountered frequently, the path to a definitive diagnosis is not always a straightforward one, and imaging offers a valuable tool to aid in this diagnostic challenge. Radiologists must be familiar with the most common etiologies of female pelvic pain in the emergency setting, their imaging characteristics, and the best way to further evaluate challenging clinical presentations. This allows the radiologist to serve as a valuable asset to the treating physician, aiding in accurate diagnosis, and in guiding the course of treatment, all while ensuring the "Image Wisely" principle. A sonographic approach to female patients presenting to the emergency setting with pelvic pain has been presented in this article and some example entities along with their imaging findings have also been reviewed.
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Affiliation(s)
- Daniel P Thut
- Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA.
| | - Michael S Morrow
- Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA
| | - Christopher C Moore
- Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA
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10
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Brar RK, Bharti JN, Nigam JS, Sehgal S, Singh HP, Ojha P. Pregnancy Luteoma in Ectopic Pregnancy: A Case Report. J Reprod Infertil 2017; 18:333-335. [PMID: 29062798 PMCID: PMC5641443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pregnancy luteoma is a rare non neoplastic condition of the ovary. It is usually asymptomatic and found incidentally during imaging in pregnancy or during cesarean section. Pregnancy luteoma can also occur after ectopic pregnancy. CASE PRESENTATION A 30 year old female presented to G.B. Pant Hospital, Andaman and Nicobar Islands institute of Medical Sciences, Port Blair in October 2015 with abdominal pain. After initial investigations, exploratory laporotomy was done for ruptured ectopic pregnancy. Enlarged ovary was removed along with the ruptured portion of fallopian tube. Histopathological examination revealed solid aggregates of large cells with abundant eosinophilic cytoplasm; diagnosis of pregnancy luteoma was given. CONCLUSION It must be considered in the differential diagnosis of ovarian masses in pregnant females that early diagnosis of this entity may avoid unnecessary radical surgery.
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Affiliation(s)
- Rupinder Kaur Brar
- Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India,Corresponding Author: Rupinder Kaur Brar, 306, Andaman teal house, delanipur, Port Blair, India. Pin-744102 E-mail:
| | | | | | - Sahil Sehgal
- Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India
| | | | - Pushpanjali Ojha
- Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India
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11
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Luteoma of Pregnancy Presenting with Severe Maternal Virilisation: A Case Report. Case Rep Obstet Gynecol 2016; 2016:3523760. [PMID: 27660728 PMCID: PMC5021856 DOI: 10.1155/2016/3523760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 11/27/2022] Open
Abstract
Luteoma of pregnancy is a rare, benign condition characterized by a tumor-like mass of the ovary that emerges during pregnancy and regresses spontaneously after delivery. It is usually asymptomatic and the diagnosis is generally incidental. Luteoma arises from the proliferation of luteinised cell under the influence of β-hCG and can be hormonally active, with production of androgens resulting in maternal and fetal hirsutism and virilisation. We report a case of a 25-year-old primigravida who presented at 28 weeks of gestation with virilisation symptoms. Serum androgen levels were seven-hundred-fold higher than normal. A diagnosis of pregnancy luteoma was made at the time of caesarean section. The ovarian mass, serum androgen levels, and the condition of the patient improved after delivery.
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12
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Spontaneous ovarian hyperstimulation syndrome with primary hypothyroidism: Imaging a rare entity. Radiol Case Rep 2015; 10:1050. [PMID: 27408661 PMCID: PMC4921160 DOI: 10.2484/rcr.v10i1.1050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ovarian hyperstimulation syndrome is a disorder associated with ovulation induction and is rarely seen in pregnant women. Very few cases of spontaneous ovarian hyperstimulation syndrome have been reported in a woman who is neither pregnant nor undergoing ovulation therapy. This case report describes how spontaneous ovarian hyperstimulation syndrome is associated with primary hypothyroidism in a 25-year-old, nonpregnant woman who is not on ovulation induction therapy. Imaging and laboratory findings confirmed the diagnosis of this rare entity, which aided the clinicians in providing prompt management and in preventing further complications.
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13
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Nanda A, Gokhale UA, Pillai GR. Bilateral pregnancy luteoma: a case report. Oman Med J 2014; 29:371-2. [PMID: 25337317 DOI: 10.5001/omj.2014.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/15/2014] [Indexed: 11/03/2022] Open
Abstract
Pregnancy luteoma is a non-neoplastic lesion of the ovary occurring during pregnancy and is usually discovered incidentally at the time of a cesarean section or during postpartum tubal ligation. An accurate diagnosis is important for the mother and the fetus as it can be confused with ovarian malignancy leading to unnecessary surgery. We report a case of a pregnant female who was discovered to have bilateral enlarged ovaries at the time of emergency cesarean section.
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Affiliation(s)
- Annu Nanda
- Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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Park SB. Features of the hypointense solid lesions in the female pelvis on T2-weighted MRI. J Magn Reson Imaging 2014; 39:493-503. [PMID: 24532374 DOI: 10.1002/jmri.24512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Sung Bin Park
- Department of Radiology; Chung-Ang University Hospital, Chung-Ang University College of Medicine; Seoul Korea
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