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Pelvis » Female Pelvis (Gynecology)
Polycystic Ovarian Syndrome (PCOS)
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Author(s) :
Daniel Merton
Presentation This 28 year old female G0 P0 was referred for a pelvic sonogram because her GYN physician identified enlarged ovaries on physical examination.
Caption: Long axis view of the uterus
Description: This is a relatively small uterus with a thin (Grade I) endometrial lining. Multiple small cysts are demonstrated along the endocervical lining and a larger cyst in the posterior cervical wall (most likely a Nabothian cyst)
Caption: View of the left ovary
Description: This image of the ovary demonstrates a typical PCOS appearance with multiple small (<10mm) follicles located around the periphery.
Caption: left ovary
Description: This image of the ovary also demonstrates multiple small (<10mm) follicles located around the periphery and a lack of follicles in the center of the ovary. The left ovary measured 48x38x39mm.
Caption: Short axis view of the right ovary
Description: This image of the ovary again demonstrates multiple small (<10mm) follicles located around the periphery of the ovary.
Caption: Long axis view of the right ovary
Description: The right ovary measured 45x38x40mm
Caption: CDI-guided spectral Doppler analysis of the left ovary
Description: A normal arterial blood flow pattern is demonstrated which rules out ovarian torsion.
Differential Diagnosis

ovarian torsion
bilateral ovarian neoplasms
polycystic ovarian syndrome (PCOS) or Stein - Leventhal Syndrome

Final Diagnosis Polycystic ovarian syndrome (Stein - Leventhal Syndrome) with incidental findings of multimple small cervical cysts (most likely Nabothian cysts).

Polycystic ovarian syndrome (PCOS) is a common (prevalence of 4 to 12%) endocrine disorder in women of reproductive age. Patients with this disease can present with hirsutism and amenorrhea, the latter of which can lead to infertility. PCOS (AKA Stein - Leventhal Syndrome) is a combination of biochemical, clinical, and endocrinologic abnormalities particularly those related to metabolism of androgens and estrogen.

Endovaginal sonography is the imaging modality of choice to assess ovarian morphology in patients suspected of having PCOS. Sonography will typically demonstrate bilaterally enlarged ovaries that have a rounded shape (as opposed to a normal ovoid shape). Numerous small (<10mm) immature follicles will be identified most commonly around the periphery of each ovary (the "string of pearls sign"). A thickened ovarian capsule may also be identified. 

This case demonstrates the typical appearance of PCOS ovaries (enlarged with multiple small follicles at the periphery). A Doppler assessment of flow within each ovary can be used rule out ovarian torsion (which can also result in enlarged ovaries). 

Multiple small cysts in the uterine cervix were an incidental finding. These most likely represtent Nabothian cysts.  

Technical Details Scanner: Siemens Elegra
Transducer: 6.5MHz Endocavitary probe
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