Review of pelvic masses aspirated under ultrasound guidance

Objective The purpose of the study was to assess the utility and importance of ultrasound-guided aspiration of pelvic masses and to review our experience. Method 186 cases of pelvic masses were referred to our Ultrasound Clinic in Karachi from February 2008 to December 2018. Based on Ultrasound criteria, diagnosis of cysts, abscesses, endometriomas and pelvic collections were made. Diagnostic/ therapeutic aspirations were carried out. Masses were aspirated per-abdominally by free-hand technique whereas endovaginal aspirations were done via puncture adapter technique. 14-18 gauge needles were used based on the viscosity of the fluid as determined by the zone of enhancement. All patients were reassessed after 15 days to evaluate any pain, discomfort, spill or recurrence. Result After meeting the selection criteria, 186 cases of pelvic masses were aspirated. Out of them, 18 turned out to be ovarian abscesses whilst 120 were chocolate cysts (endometriomas). 7 peritoneal abscesses and 4 psoas abscesses were also drained. 28 were found to be ovarian cysts with clear transparent fluid and 9 were found to be ovarian cysts with a tinge of red or dark yellow fluid. On follow-up, recurrance was observed in 28 patients (18.8%), 8 patients (5.4%) complained of mild pain and slight discomfort right after the procedure which was relieved by Panadol. No fluid collection was seen in the cul de sac Conclusion Ultraound-guided aspiration of pelvic masses is a relatively safe, simple and cost-effective alternative to more invasive methods such as laproscopy and laparotomy. The paper will highlight the sonographic features of different cystic masses with special reference to ovarian abscesses versus endometriomas.