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| Fig-1. Shows Multiple well-defined cysts with homogeneous low-level internal (“ground-glass”) echoes, smooth walls, and no internal vascularity |
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| Fig-2. Shows A well-defined cyst with homogeneous low-level internal echoes (“ground-glass” appearance) |
Whole abdomen & pelvis sonography
Technique:Convex 3.5–5 MHz probe; longitudinal and transverse planes of upper abdomen; color Doppler evaluation of portal vein and hepatic vessels; pelvic and post-void images obtained. Fasting: 6–8 hours.
Prior studies: No prior available
Clinical history: Pelvic Pain
Findings
Liver:Normal in size. Echotexture homogeneous. No discrete focal lesion identified in the visualized liver. Intrahepatic biliary radicles not dilated.
Gallbladder & biliary tract:Gallbladder well distended. Wall normal. Lumen is echo-free. No pericholecystic fluid. Common bile duct (CBD) diameter within expected limits for age. No intrahepatic biliary dilatation.
Pancreas: Pancreatic head and body partially visualized; contour preserved; no focal mass seen in the visualized portion. Examination limited by overlying bowel gas.
Spleen:Normal polar length. Homogeneous echotexture. No focal lesion identified.
Right kidney:Size: Normal. Preserved corticomedullary differentiation. No hydronephrosis. No renal mass or stone detected.
Left kidney:Size: Normal. Preserved corticomedullary differentiation. No hydronephrosis. No renal mass or stone detected.
Urinary bladder:Adequately distended pre-void. Wall smooth; no intraluminal mass or debris. Post-void residual: nil.
Uterus: Anteverted, normal size and myometrial echotexture. Endometrium within normal limit. No focal lesion.
• Cyst 1: 105 × 74 cm
• Cyst 2: 60 × 44 cm All cysts show homogeneous low-level internal echoes (“ground-glass” appearance), smooth walls, and no internal vascularity—features suggestive of multiple ovarian endometriomas.Left ovary demonstrated normal in size and priserved echotexture. No cyst or mass lesion.
Ascites / free fluid:No free fluid identified in the hepatorenal recess, Morrison's pouch, or pelvis.
Abdominal aorta:Visualized abdominal aorta measures normal in diameter (proximal). No aneurysmal dilatation or mural thrombus seen.
Measurement Summary
Liver: 140 mm (MCL)
Spleen: 90 mm (Bipolar length)
Rt. Kidney: 120 mm Length )
Left Kidney: 130 mm
Uterus VOL-: 45 mL
Other observations: Linear 7.5–10 MHz probe, longitudinal and transverse planes of small parts of abdomen. No evidence of abdominal lymphadenopathy. The para-aortic, mesenteric, porta hepatis, and iliac regions show no enlarged or abnormal lymph nodes. Any visualized lymph nodes are oval, with preserved fatty hilum and normal echotexture.
Bowel: Demonstrate normal wall thickness and preserved wall layering. No abnormal dilatation, thickening, or pericolic fluid noted. Peristalsis is normal. No evidence of obstruction, mass, or inflammatory bowel changes.
Abdominal wall: Demonstrates normal layered architecture and echotexture. No evidence of hernia, mass lesion, edema, or localized collection. Subcutaneous tissues and musculature appear normal..
Impression / Conclusion:📋 Multiple right ovarian endometriotic cysts (Right ovarian Ovarian endometrioma/chocolate cyst).
Recommendations: Correlate with symptoms and CA-125 if clinically indicated. Consider follow-up ultrasound in 6–12 weeks for interval assessment, or gynaecology referral for persistent/enlarging lesion or symptomatic patients. Management decisions should be individualized.
Examination mildly limited due to suboptimal acoustic window, possible bowel gas interference, and patient-related factors. However, major pelvic structures were satisfactorily evaluated.
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