Ovarian and Adnexal Masses, Ovarian Torsion, and Pelvic Inflammatory Disease — WACS Viva & Clinical Scenarios (Obstetric and Gynaecological Imaging)

Exam-style ovarian and adnexal masses, ovarian torsion, and pelvic inflammatory disease viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A 24-year-old female presents to the emergency department with sudden-onset, severe right lower quadrant pain and nausea. Transvaginal and transabdominal Doppler ultrasound shows an enlarged right ovary measuring 5.8 cm in maximum dimension with peripherally displaced cortical follicles and absent venous flow, though resistive arterial waveforms are still detectable. Detail the multi-modality imaging manifestations of ovarian torsion, discuss the physiological basis for preserved arterial Doppler flow, and outline the immediate reporting priorities.
• SCENARIO 2: Detail the morphological and multi-parametric imaging features that differentiate benign non-neoplastic and neoplastic adnexal masses on ultrasound and magnetic resonance imaging (MRI), specifically comparing mature cystic teratoma (dermoid cyst), ovarian endometrioma, hemorrhagic functional cyst, and ovarian serous/mucinous cystadenoma.
• SCENARIO 3: Explain the risk stratification of adnexal lesions using the American College of Radiology O-RADS (Ovarian-Adnexal Reporting and Data System) ultrasound classification from O-RADS 1 to O-RADS 5. Detail the quantitative and qualitative morphological descriptors, including color Doppler scoring, and describe the clinical management pathways associated with each tier.
• SCENARIO 4: A 28-year-old female with a history of recurrent pelvic pain presents with high-grade fever, purulent cervical discharge, and severe bilateral adnexal tenderness. Ultrasound and contrast-enhanced CT reveal complex adnexal abnormalities. Detail the radiological progression and imaging hallmarks of Pelvic Inflammatory Disease (PID), spanning endosalpingitis, hydrosalpinx, pyosalpinx, and Tubo-Ovarian Abscess (TOA), including specific differentiating signs on ultrasound, CT, and MRI.
• SCENARIO 5: Discuss the differential diagnosis of complex cystic-solid pelvic masses in a reproductive-aged female, outlining the imaging criteria used to distinguish a ruptured or complicated Tubo-Ovarian Abscess from acute appendicitis with pelvic peritonitis, ectopic pregnancy, and a twisted or degenerating ovarian neoplasm.