Ultrasound examination with color doppler ultrasonography in patients with ovarian apoplexy

Abstract

Objective. The aim of the study was to assess the value of ultrasound (US) examination with Color Doppler (CD) in patients with ovarian apoplexy.

Full Text

Methods. We performed transvaginal US-examination in 30 patients with ovarian apoplexy: 1) in acute period of ovarian, rupture if they had stable indicators of hemodynamics (on admission to hospital before the surgery - laparoscopy); 2) during follow-up in ovulatory period and in luteal phase of menstrual cycle in 1, 3, 6, 9 and 12 months after surgery. Follow-up US examination was combined with CD (CD-system - Acuson 128 ХР/IO). The control group consisted of 10 women with normal ovulatory menstrual cycle.

Results. I. The ovary of normal size (do not exceed 4,5 cm in diameter) containing a few hypoechogenic spherical spaces 1,5-2,5 cm in diameter, the ovarian follicles, which are located peripherally (in 20 patients) or spherical cystic mass 5-7 cm in diameter with echo-signs of corpus luteum cyst (in 10 patients) were visualized by US examination in acute period of ovarian apoplexy. Corpus luteum cyst's rupture was characterized by appearance of hypoechogenic small dispersive cystic fluid (blood) with the highly echogenic structures (blood clot); of numerous components of different echogenicity - septaes (fibrin's fibers) or of delicate network (site of corpus luteum's vascularization and luteanizatin). Mild or medial volume of fluid in cul-de-sac was detected by US, echo-free in 14 patients or small dispersive in 16 patients. US-findings were confirmed by laparoscopy in all cases. 2. US-CD-follow-up after the laparoscopy allowed to reveal structure-functional ovarian changes (absence of ovulation in 18 cases, ovarian cysts in 24 cases) and vascular-hemodynamic disorders - reliable rise (p<0,05) of ovarian flow's characteristics (TR=0,52±0,05; Pl=0,72±0,07, S/D=2,19±0,11) in comparison with control group (0,48±0,04; 0,64±0,1; 1,96±0,17 accordingly). The extent and stableness of hemodynamic disorders of ovarian flow correlates with volume of intraabdominal hemorrhage caused by ovarian rupture.

Conclusions. US examination is a valuable method for the diagnosis of ovarian apoplexy allowing to specify the form of this disorder and choose the optimal management of patients with ovarian rupture. US-follow-up makes it possible to evaluate structural and functional ovarian changes (absence of ovulation, ovarian cysts). Use of CD allows to register highly resistant flow in basin of a. ovarica and to follow the normalization of hemodynamic indicators of ovarian flow in patients with ovarian apoplexy.