Pelvic Doppler Pathology
Corpus Luteal Cyst
 The Corpus luteal is formed when the mature follicle ruptures, in the normal
process leading to regression doesn’t occur a Corpus Luteal cyst is formed.
 The corpus luteal starts as a hypoechoic structure, with irregular walls that
may contain internal echoes. If haemorrhage into the cyst occurs the
appearance may be more consistent with a solid complex mass.
 When the regression phase fails a corpus luteal cyst exists of varying size.
 The angiogenic ring around the dominant follicle is most prominent before
ovulation and continues to increase after ovulation giving the ‘ring of fire’
appearance. (A similar appearance maybe seen around an extrauterine
gestation sac).
http://www.glowm.com/images/embryo_02_corpus-luteum-copia.jpg
Ectopic Pregnancy
 Colour Doppler can aid with the visualisation of placental flow around the
gestation sac of an intrauterine pregnancy and aid with the differential
diagnosis of a pseudo-sac, when a foetal pole or yolk sac are not
demonstrated.
 There is a higher probability of an ectopic pregnancy occurring on the same
side as the Corpus Luteal Cyst- the ring of fire’ colour Doppler appearance
aids in visualisation of a Corpus Luteum although care must be taken as a
similar appearance is seen around an extra uterine gestation sac.
http://php.med.unsw.edu.au/embryology/images/f/f0/Ectopic_01.jpg
http://eso-cdn.bestpractice.bmj.com/best-practice/images/bp/en-gb/174-2_default.jpg
Corpus Luteum versus Ectopic Pregnancy Doppler images
http://www.jaypeejournals.com/eJournals/_eJournals%5C40%5C2009%5CJulySeptember%5Cimages/6-9B.jpg
Fibroids
 Doppler ultrasound is of limited use when imaging fibroids as there are a wide
range of velocity values.
http://radiographics.rsna.org/content/25/5/1159/F1.large.jpg

One particular area where Colour Doppler maybe useful is when imaging a
pedunculated fibroid, if the vascular pedicle is clearly demonstrated between
the uterus and the pedunculated fibroid this aids with the differentiation
between fibroid or adnexal mass.
http://www.gynaecology.spotmysite.com/users/202/assets/fibroid%20with%20stalk%20for%20t
he%20net.jpg?79
Ovarian Torsion
 The failure to detect arterial flow within the ovary may lead to the diagnosis of
ovarian torsion. Colour and pulsed wave Doppler maybe used.
 Colour Doppler may aid with the visualisation of the ovarian vessels and may
demonstrate a coiling or twisting of these vessels.


Ovarian flow has been detected with ovarian torsion this maybe due to the
dual blood supply.
Chronic torsion may show an absence of internal flow but positive periphery
flow.
https://www.med-ed.virginia.edu/courses/rad/edus/text%20jpegs1/16b-TorsionLOV.jpg
Uterine Arteriovenous Malformations
 Are a vascular plexus of arteries and veins that exist without the intervening
plexus of capillary networks
 They are a rare occurrence and usually are involving the myometrium and
occasionally the endometrium.
 Colour flow demonstrates an abundant colour mosaic.
 Spectral Doppler demonstrates a high velocity waveform with a low
resistance. It is often impossible to differentiate between the arterial and
venous flow.
http://www.webmedcentral.com/articlefiles/8297e6f6162b1dd51c75ee511ebdc330.jpg
Gestational Trophoblastic Disease
 The classic ultrasound appearance is of multiple cysts of varying size
replacing the placental tissue.
 There are three main classifications of disease
1. Classical or complete mole
2. partial or incomplete mole
3. Co-existing mole and foetus.
 Doppler of this appearance is of high velocity and low resistance waveforms.
http://www.sasuog.org.za/subsiteTeachings/images/Trophoblast/Uterus_Colour_WEB.jpg
Polycystic Ovaries
 Polycystic ovarian syndrome is classified as a functional abnormality leading
to the presentation of hyperandrogenism, unovulation and various metabolic
disorders.
 Ultrasound is of a limited value as the interpretation of results is variable.
Clinical Presentation
Clinical presentation of Polycystic ovaries may involve any of the following;
o Amenorrhoea
o Oligomenhorrea
o Infertiliy
o Obesity
o Acne
o Alopecia
Ultrasound presentation
o May present with;
o Increase in the size of the ovaries
o An increase in stromal thickness
o An increase in the echogenicity of the ovary
o An increase in the number of follicles
o The ring of Pearls appearance.
Doppler Presentation
o May show an increase in the stromal vascularity.
http://www.jaypeejournals.com/eJournals/_eJournals/46/2009/OctoberDecember/images/15-1.jpg
o A decrease in the impedance of the ovarian artery (a decrease in
Resistive Index).
o An increase in the RI of the Uterine Artery.
o When comparing the Doppler component of the examination with a
‘normal’ ovarian signal, the menstrual phase must be considered.
o Polycystic Ovaries are thought to present with an increase in ovarian
flow throughout the menstrual cycle due to the lack of luteal
conversion. The vessels are generally prominent with a low resistant
waveform.
https://lms.curtin.edu.au/bbcswebdav/pid-2257129-dt-contentrid9049992_1/courses/310696-FacSciEng-1729436055/Module%20One%20
%20Advanced%20Doppler%20Physics2013.pdf