Peritoneal pseudo and ovarian cysts are frequent ultrasonic dilemma: an Egyptian experience

Introduction

Peritoneal pseudo cysts (PPCS) are formed due to trapping and collection of the fluid arising from the ovary into post inflammatory or postoperative adhesive pockets in peritoneal cavity. These appear as complex multicystic adnexal masses on sonography. Unfortunately, although fairly common-due to increased pelvic surgery like caesarean section, many gynecologists and ultrasonographers are not aware of them, leading to less recognization on imaging of the female pelvis or falsely diagnosed as true ovarian cysts.This can lead to unnecessary surgical interference.

Objective

To highlight Egyptian (Mansoura) experience regarding, the guidelines needed for diagnosis of( PPCS), and to distinguish them from true ovarian cysts.

Methods

223 women with ovarian cysts were subjected to transvaginal sonography (TVS),combined with power Doppler and plasma concentrations of CA 125 before surgery. 62 women with (PPCs )were diagnosed on surgical intervention and correlated to ( TVS). Case series study regarding The diameters of the cysts, the shape, margins, content, location, presence of septa and echogenicity were analyzed.

Results

The( PPCs) were unilateral in 40 (65%) and bilateral in 22 (35%) women. A well-defined cystic structure was found in only 12 (19%) women, while in the other 50 (81%) women the( PPCs )showed blurred, undefined margins and a bizarre morphology, giving them lumpy shape. The ipsilateral ovary was identified in 52 (84%) cases, either external to the cyst or entrapped within it.

Conclusions

 peritoneal pseudo cysts are presented with a variety of imaging appearances which can be confused with a long list of differential diagnoses, including ovarian cancer. Preoperative diagnosis depends on the presence of normal ipsilateral ovary with surrounding loculated fluid conforming to the peritoneal space. Although TVS is sufficient for diagnosis,but the normal CA125 and power doppler increase the sensitivity of TVS.

Keywords

Peritoneal pseudo cysts, ovarian cysts, ultrasonic