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.