Polycystic Ovary Syndrome (PCOS/PCOD)

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PCOS/PCOD ultrasound case study

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Reporting Panel

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Ovarys Pathology

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Polycystic Ovary Syndrome (PCOS/PCOD) ultrasound case study

CASE–1

Clinical History

Patient was referred for pelvic ultrasound due to irregular menstrual cycles, infertility, hirsutism, acne, or suspected polycystic ovarian syndrome. Clinical and biochemical correlation is advised.

Ultrasound Findings

Ultrasound examination demonstrates bilateral enlarged ovaries containing multiple small peripheral follicles measuring approximately 2–9 mm in diameter, arranged in a characteristic "string of pearls" appearance. The ovarian stroma appears mildly increased in echogenicity with increased stromal volume. No dominant follicle, adnexal mass, or free fluid is identified. The uterus demonstrates normal size and echotexture.

Report Line

Both ovaries are enlarged and demonstrate multiple (≥20) small peripheral follicles measuring approximately 2–9 mm with increased central stromal echogenicity, producing a characteristic "string of pearls" appearance. The findings are suggestive of bilateral polycystic ovaries (PCOD/PCOS morphology). Clinical and biochemical correlation is recommended.

Impression

Features are consistent with bilateral polycystic ovarian morphology (PCOM), suggestive of PCOD/PCOS in the appropriate clinical setting. Correlation with clinical findings and hormonal profile is recommended for the diagnosis of polycystic ovary syndrome.

Key Learning Points

• PCOS is diagnosed using a combination of clinical, biochemical, and imaging findings.
• Ultrasound typically demonstrates bilateral enlarged ovaries with multiple peripheral follicles measuring 2–9 mm.
• Increased ovarian stromal volume and echogenicity are common sonographic features.
• The characteristic "string of pearls" appearance supports the diagnosis of polycystic ovarian morphology.
• Ultrasound findings alone do not establish the diagnosis of PCOS.
• Differential diagnoses include multifollicular ovaries, ovarian hyperstimulation, and normal physiological follicular development.
• Clinical correlation using the Rotterdam criteria is essential for definitive diagnosis.

Recommendation

Correlation with clinical symptoms, serum hormonal profile, and the Rotterdam diagnostic criteria is recommended. Gynecological or endocrinological consultation may be considered for comprehensive evaluation and management.