From the Guidelines
Dilated adnexal vessels should be evaluated through a comprehensive pelvic examination, additional imaging studies like Doppler ultrasound or MRI, and possibly blood tests to check for inflammatory markers or pregnancy, as they may indicate various underlying conditions, including pelvic inflammatory disease, ovarian cysts, ectopic pregnancy, ovarian torsion, or pelvic congestion syndrome. The clinical significance of dilated adnexal vessels varies widely, and proper diagnosis is essential for appropriate management. According to the most recent study 1, the best approach for evaluating adnexal masses, which may be associated with dilated adnexal vessels, is through ultrasound, including transabdominal and transvaginal ultrasound, as it provides accurate and safe assessment.
The use of ultrasound-based scoring systems, such as the IOTA Simple Rules and the IOTA ADNEX model, can help differentiate between benign and malignant adnexal masses 1. However, it is essential to note that these systems may not be applicable in all cases, and further evaluation may be necessary.
In cases where surgical intervention is required, laparoscopic surgery is preferred over open surgery due to its benefits, including shorter hospital length of stay, less postoperative pain, and lower risks of fetal loss, preterm birth, and low birthweight 1.
Key considerations in the management of dilated adnexal vessels include:
- Comprehensive pelvic examination
- Additional imaging studies, such as Doppler ultrasound or MRI
- Blood tests to check for inflammatory markers or pregnancy
- Ultrasound-based scoring systems to differentiate between benign and malignant adnexal masses
- Laparoscopic surgery as the preferred approach for surgical intervention, when necessary.
It is crucial to prioritize the patient's safety and well-being, and to make decisions based on the most recent and highest-quality evidence available 1.
From the Research
Dilated Adnexal Vessels
- Dilated adnexal vessels can be associated with various gynecological conditions, including ectopic pregnancy and pelvic inflammatory disease 2, 3.
- Ectopic pregnancy is a condition where a fertilized ovum implants outside the uterine cavity, and it can cause dilated adnexal vessels due to increased blood flow to the affected area 2.
- Pelvic inflammatory disease (PID) is another condition that can cause dilated adnexal vessels, as it leads to inflammation and increased blood flow to the pelvic region 3, 4.
- The diagnosis of dilated adnexal vessels can be made using ultrasound visualization of the adnexa, and it is often combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels to make a definitive diagnosis of ectopic pregnancy or PID 2, 5.
- Treatment options for conditions associated with dilated adnexal vessels include medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and expectant management 2, 5.
- A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy, and proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians 5.