Radiologic Findings August 3, 2011 GYNECOLOGY TRANSVAGINAL ULTRASOUND During a transvaginal ultrasound, a tubular probe is inserted into the

vaginal canal. The probe is completely covered by a lubricated condom. The probe can be rotated slightly to obtain close contact images of the uterus and ovaries. The uterus and ovaries may be evaluated to examine abnormal pelvic growths and to determine the source of painful cramps or other pain in the pelvic area, unexplained vaginal bleeding or lack of menstrual flow. Transvaginal ultrasound may be done for the following problems: Abnormal findings on a physical exam, such as cysts, fibroid tumors, or other growths, Abnormal vaginal bleeding and menstrual problems, Certain types of infertility, Ectopic pregnancy and Pelvic pain. RESULTS Uterus: 5.77 x 4.57 x 3.29cm Cervix: 3.11 x 2.15cm Right Ovary: 2.91 x 1.14cm Left Ovary: 3.4 x 2.26cm The uterus is not enlarged and is anteverted. It is homogenous in echostructure with no local lesion. The endometrium is not thickened measuring 0.76cm and is smooth and diffusely hyperechoic. No focal mass lesion. Right ovary is normal in size with no focal lesion and no dominant follicle. Left ovary is normal in size with no focal lesion and no dominant follicle. There is a 5.8 x 4.1cm well-defined hypoechoic mass at the Left adrenal areal which is closely adherent to the Left ovary. There is a tubular structure measuring 4.2 x 2.1 x 1.4cm at the Left adrenal area which is continuous with the Left uterine cornu. No abdominal cul de sac fluid. Impression Hyperechoic mass at the left adrenal area. Dermoid is considered, please correlate clinically. Dilated Left fallopian tube. Left Hydrosalphynx is entertained. Normal size anteverted uterus with non- thickened endometrium. Normal sized Right and Left ovaries described. GYNECOLOGY TRANSVAGINAL ULTRASOUND February 23, 2012 Uterus: 5.9 x 3.5 x 3.3cm Cervix: 2.3 x 2.0 x 2.5cm Right Ovary: sec description Left Ovary: 1.5 x 1.2 2.0xm Remarks: The uterus is anteverted with regular contour and homogeneous myometrium. There are no myometrial muscles seen. The cervix is closed and the nabothian cyst. The endomyometrial and isoechoic intact myometrial interface. At the Right adrenal area is a complex mass, thick- walled biloculated measuring 7.2 x .7 x 5.0cm. Each lobule demonstrates different echopattern. The first locule measures 4.3 x 4.2 x 3.5 cm, and contains uniform low level echoes while the other locule measures 4.5 x 3.6 x 3.7cm, with an echogenic cone. Morphologic features suggestive of a right ovarian new growth (probably twisted). The left ovary is lateral to the uterus and contains follicles. Lateral to the Left ovary is an elongated cystic structure measuring 3.3

x 1.3 cm is low-medium level echoes suggestive of a dilated portion of the left fallopian tube to endometriosis vs. inflammatory process. There is free fluid with echoes seen within both adrenal areas in the posterior cul de sac probably blood. Impression: - Normal size anterverted uterus with thin and intact endometrium. - Biloculated complex mass as described. Consider the right ovarian new growth (probably twisted). - Normal left ovary. - Consider the dilated portion of the left fallopian tube secondary to endometriosis vs. inflammatory process. - Fluid with echoes within both adrenal areas and in the posterior cul de sac probably blood.

X-RAY The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. Xrays are the oldest and most frequently used form of medical imaging. A chest x-ray is typically the first imaging test used to help diagnose symptoms such as: shortness of breath, a bad or persistent cough, chest pain or injury, fever. Physicians use the examination to help diagnose or monitor treatment for conditions such as: pneumonia, heart failure and other heart problems, emphysema, etc February 22, 2012 Examinations: Chest PA RADIOLOGIC FINDINGS - Examination reveals the lung fields are clear. The cardiac silhouette is not enlarged. -The thoracic aorta and pulmonary vessels are unremarkable. -The diaphragm is sharp and distinct. -The trachea is in the midline. There are no bony abnormalities. CONCLUSION: Essentially Normal Chest.

ULTRASOUND Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound examinations do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. An abdominal ultrasound produces a picture of the organs and other structures in the upper abdomen. (Whole Abdomen) February 22, 2012 SONOGRAPHIC FINDINGS Examination reveals that the liver is normal in size and echopattern. There are no dilated intrahepatic ducts/ masses noted. There is a 1.7cm stone within the gallbladder. The gallbladder wall is not thickened. The common duct is not dilated. The pancreas is normal. The spleen is normal in size with the transverse diameter of 4.2cm. The abdominal aorta is normal. Right kidney measures 10.4 x 4.3cm. Cortical thickness is 2.0cm. Both kidneys are normal in size, shape, echogenicity and echopattern.

There is no evidence of a stone, mass or hydronephrosis. Urinary bladder is normal. There is a 6.6 x 8.0cm. Complex mass in the pelvic area with solid elements and this is probably of ovarian origin. There are multiple cysts in the left ovary. CONCLUSION= 1.7cm gallbladder stone, no evidence of cholecystitis. = 0.0cm complex mass right ovary

(FROZEN SECTION) Biopsies are small samples of tissue taken from a mass or tumor that are examined under a microscope to make a diagnosis. Biopsies are used most often to determine whether cancer cells are present, although certain infections and other diseases can be diagnosed as well. A specific type of biopsy procedure called the frozen section was developed in order to make a rapid diagnosis of a mass during surgery. Gross: Section shows a biloculated cyst the inner wall of which exhibits adherent blood clots. No papillary excrescences are seen. Frozen Section Dx: Benign hemorrhagic ovarian cyst suggestive of Endometriotic origin Microscopic: Edematous ovarian tissue forming a thick cyst wall. The cyst is for the most part unlined by epithelium but focally by columnar cells. Congestion and hemorrhages are prominently seen. Laminal surface shows hemosiderin-laden histiocytes Frozen section Dx: Right Ovary; endometriotic cyst