Answer: In general, either a CT or MRI is useful for further characterizing a hepatic lesion as well as for evaluation of extrahepaticdisease. In either modality, multi-phase contrast imaging is important for delineating the enhancement and washout pattern of a lesion.
Before any additional imaging is performed, it is critical to first review any prior imaging. A CT scan from two years earlier was in fact available, and showed a mixed solid-cystic structure of similar size in the same region identified by ultrasound (red arrows). A vascular bundle extended from the structure toward the abdominal great vessels (yellow arrows).
Diagnosis: Ovarian transposition.
- Ovarian transposition, or oophoropexy, is a surgical ovary-sparing procedure for patients undergoing pelvic radiation therapy. One or both ovaries are laparoscopically mobilized to outside of the pelvis and repositioned in the abdominal cavity, away from the radiation field.
- It is done for preservation of fertility, hormonal function, or both.
- The procedure is not performed in post-menopausal women. Relative contraindications include age > 40 years and patients at moderate risk for metastases to the ovaries.
- If oocyte cryopreservation is planned, all visible follicles are aspirated at the time of the procedure.
- The procedure has a 65% - 75% success rate
Barahmeh, S., Masri, M., Badran, O., Masarweh, M., El-Ghanem, M., Jaradat, I., & Lataifeh, I. (2013). Ovarian transposition before pelvic irradiation: Indications and functional outcome. J Obstet Gynaecol Res Journal of Obstetrics and Gynaecology Research, 1533-1537.
Tulandi, T ,et al. Ovarian transposition before pelvic radiation In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
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