Simple vs ugly adnexal lesions: is ultrasonography alone good enough?


  • Rahul Dev Chauhan Department of Radiology, Military Hospital, Ambala, Haryana, India
  • Yashvir Mathur Department of Radiology, Military Hospital, Ambala, Haryana, India



Adnexal lesion, Benign, Laparoscopy, Follow up, Ultrasound


Background: Ultrasound (USG) is easily available and effective imaging modality for adnexal lesions. A simple looking lesion on ultrasound is usually benign and an ugly looking adnexal lesion is either benign or malignant. This study aims to evaluate the varied appearance of simple and ugly benign adnexal lesions on USG and to find out any additional role of colour Doppler in such suspected benign lesions. The confirmation of diagnosis was done either by follow up appearance of lesions on USG or by histopathological evaluation.

Methods: A total of 55 consecutive female patients with age between 18 to 50 years were enrolled in this prospective cross sectional study. USG and colour Doppler for all the lesions were done. The patients found to have malignant lesions on histopathological examination, were later excluded from the analysis. Follow up USG was done for all the cases. Those cases wherein there was no resolution of lesions even after 08 weeks, were given an option to undergo laparoscopy as next management step.

Results: Out of 50 benign adnexal masses, 88% masses were ovarian in origin and 12% were tubal masses. Ovarian masses included hemorrhagic cysts, endometriosis, simple cysts, serous cystadenomas and ovarian dermoid. All extra-ovarian masses were hydrosalpinx. Colour Doppler did not add any additional finding. Some of the patients underwent diagnostic laparoscopy followed by excision of masses in majority of them.

Conclusions: Benign adnexal lesions can have varied appearance ranging from simple to ugly on USG. Ultrasonographic features of benign lesions on USG can be appreciated very well even without further use of colour Doppler or cross sectional imaging. Follow up USG remains key modality for benign adnexal masses in absence of MRI.


Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization-meta-analysis and Bayesian analysis. Radiology. 2005 Jul;236(1):85-94.

Russo A, Calò V, Bruno L, Rizzo S, Bazan V, Di Fede G. Hereditary ovarian cancer. Crit Rev Oncol Hematol. 2009 Jan;69(1):28-44.

Jain KA, Friedman DL, Pettinger TW, Alagappan R, Jeffrey Jr RB, Sommer FG. Adnexal masses: comparison of specificity of endovaginal US and pelvic MR imaging. Radiology. 1993 Mar;186(3):697-704.

Hricak H, Chen M, Coakley FV, Kinkel K, Yu KK, Sica G, Bacchetti P, Powell CB. Complex adnexal masses: detection and characterization with MR imaging-multivariate analysis. Radiology. 2000 Jan;214(1):39-46.

Adusumilli S, Hussain HK, Caoili EM, Weadock WJ, Murray JP, Johnson TD, Chen Q, Desjardins B. MRI of sonographically indeterminate adnexal masses. Am J Roentgenol. 2006 Sep;187(3):732-40.

Patel MD, Feldstein VA, Filly RA. The likelihood ratio of sonographic findings for the diagnosis of hemorrhagic ovarian cysts. J Ultrasound Med. 2005 May;24(5):607-14.

Valentin L. Use of morphology to characterize and manage common adnexal masses. Best Pract Res Clin Obstet Gynaecol. 2004 Feb 1;18(1):71-89.

Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006 Feb 1;16(2):285-98.

Timor-Tritsch IE, Lerner JP, Monteagudo A, Santos R. Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system. Am J Obstet Gynecol. 1993 Mar 1;168(3):909-13.

Brown DL, Zou KH, Tempany CM, Frates MC, Silverman SG, McNeil BJ, et al. Primary versus secondary ovarian malignancy: imaging findings of adnexal masses in the Radiology Diagnostic Oncology Group Study. Radiology. 2001 Apr;219(1):213-8.

Benacerraf BR, Abuhamad AZ, Bromley B, Goldstein SR, Groszmann Y, Shipp TD, Timor-Tritsch IE. Consider ultrasound first for imaging the female pelvis. Am J Obstet Gynaecol. 2015 Apr 1;212(4):450-5.

Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M, et al. Developing an MR imaging strategy for diagnosis of ovarian masses. Radiographics. 2006 Sep;26(5):1431-48.

Togashi K, Nishimura K, Itoh K, Fujisawa I, Sago T, Minami S, et al. Ovarian cystic teratomas: MR imaging. Radiology. 1987 Mar;162(3):669-73.




How to Cite

Chauhan, R. D., & Mathur, Y. (2019). Simple vs ugly adnexal lesions: is ultrasonography alone good enough?. International Journal of Research in Medical Sciences, 7(8), 3020–3025.



Original Research Articles