Reason: adnexal mass History: pelvic pain. Additional history per Epic: Patient is status post left oophorectomy possible salpingectomy in 1999 for question ectopic pregnancy. Patient also has a history of myomectomy in 2011. PELVIS:UTERUS, ADNEXA: The uterus is mildly enlarged. There are at least two degenerating intramural uterine fibroids identified. The larger within the left uterine fundus, measuring 19 x 16 mm.There are multiple cysts within the junctional zone which is thickened and heterogeneous, suggesting adenomyosis (series 9, image 14). The endometrium is within normal limits in thickness, measuring 5 mm.Multiple cysts are present in the lower uterine segment, some of which demonstrate slightly complex signal intensity, the largest measures 18 x 10 mm (series 9, image 13), compatible with nabothian cysts. There are scattered small foci of T1 signal hyperintensity along the uterine serosa, compatible with endometriosis.In the left adnexa is a large, dilated, tubular structure, which is blind-ending and a simple appearing cystic lesion, measuring 8.5 x 7.5 cm, compatible with severe left hydrosalpinx. There is no diffusion restriction to suggest pyosalpinx. The left ovary is not identified. There is no solid mural components or enhancement on postcontrast imaging.The right ovary is somewhat atrophic in appearance with small physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy is noted.BOWEL, MESENTERY: The bowel is normal caliber without evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative disc disease affects the lower lumbar spine with small disc protrusions at L4-5 and L5-S1.OTHER: No significant free fluid.
1.Large blind-ending tubular structure in the left adnexa compatible with severe hydrosalpinx, without evidence of infection/pyosalpinx.2.Scattered endometriosis implants along the uterine serosa.3.Thickened and heterogeneous junctional zone with multiple small cystic regions, compatible with adenomyosis.4.Several nabothian cysts, some of which appear complex.