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Need help understanding sonohystogram results
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Need help understanding sonohystogram results

Since I didn't get any responses to my original post, I'm trying again to see if someone can put my worries to rest.

Yesterday I received a copy of the report from the sonohystogram I had done last week. If anyone can give me feedback on what this means, especially regarding the findings on the ovaries and the "fluid in the cul-de-sac", I would greatly appreciate it. Here's the US findings verbatim:

Uterus is 6.44x3.61x4.75cm, in AV position, and contour & echotexture WNL.
Endometrium is 1.1mm with 0.93x0.41cm hyperechoic(?? on spelling) structure mid-uterus that is obscuring endometrium.

There is a 2.06x1.91x2.22cm area of fluid in cul-de-sac.

Left ovary is 2.91x2.78x2.81cm
Right ovary is 3.32x2.02x1.66cm with 1.05x0.80x0.95 hypoechoic area within rigth ovary.

Filling defects: 1.00x0.42x1.15cm hyperechoic filling defect mid-uterus(c/w structure noted above). Has polypoid appearance. Fluid retained.
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http://www.drcook.com/glossary.html
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I don't have personal experience with uterine abnormalities. But I will try to help you with the wording:
The "Filling defects" is basically a summary of any findings...... They see a hyperechoic defect(meaning many echoes..-debris that the u/s waves bounce off of-...which usually means the area is more solid than it is cystic, which would have said hypOechoic).... in your uterus. The defect is 1cm which is half an inch. Has polypoid appearance....meaning of or resembling polyps. Maybe it's a serosal cyst of the uterus or a fibroid. Either way, they will watch to see if it grows with follow up u/s.
There is small amount of fluid in the cul-de-sac region of your pelvis. The left ovary is normal. The right ovary has a tiny simple cyst, which most women have every month and they shrink away without incident. It is simple because it has no echoes (hypoechoic). Hope you understand the terminology better now! Take care,
(((Raynbow
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Thank you for responding! Now I feel a little bit better.

As for the polyp on my uterus, I'm actually going to have a D&C to remove it. I figured I don't need to take chances by playing the wait-and-see game. Plus, I'm not really enjoying menstruating every 1-2 weeks like I have been.

I do have a question for you based on your interpretation of my US. How did you conclude that the cyst on my right ovary was a simple cyst? The reason I'm asking is because there is no wording in the report to identify it as such and the doctor did not specifically call it that. In fact, the doctor seemed really concerned about the cyst & the fluid in the pelvis and wants to do repeat ultrasounds in 3 months to check their status.

Anyways, thanks for your help. I truly appreciated your feedback.  
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I do see where I've made a contradicting remark.....Hyperechoic has many internal echoes or debris...Hypoechoic (such as yours), gives off FEWER echoes than the surrounding tissue... (hyper and hypo are opposites)
Since yours isn't "echo free", it would actually be complex, not simple. My mistake...However, this is probably a hemorrhagic cyst that is essentially a simple cyst that most women get during ovulation but then it bleeds into itself a bit and causes the look of debris inside the cyst. It usually shrinks away on its own (even if it were 3cm instead of 1cm) Just relax and see what happens, it's gonna' be okay....Try to read up on hemorrhagic cysts and see how common these are to all women, we just don't always know about them because they normally don't cause trouble.
%99 of cysts are benign and most don't require surgery until they are 5cm or more. I've had 2 surgeries for benign tumors, and more fluid in my pelvis than yours, my follow ups were every 6wks. I'm currently doing 1month follow up for a new ovarian problem. I'm just doing my best to tell you what I know based on experiences. Hope I clarified any problems...
Take Care,
((( Raynbow
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THAT'S WHY THEY HAVE THIS FORUM....SO "SPAZ"s LIKE US CAN RELIEVE OURSELVES! LOL ....HERE'S SOME POSTS FROM BACK IN MAY OF 2006 THAT MAY HELP YOU....

05/18/06
  As far as I know, cyst ruptures are very common and not worrisome. Usually "functional" ovarian cysts are the cysts that rupture. A functional cyst means that it is formed during your normal ovulation cycle. Technically, every month a woman has a cyst rupture during ovulation. Usually when it ruptures, the casing dissolves. Sometimes it doesn't and can fill up with fluid or blood, or other times it doesn't rupture on tme, can grow larger, and then rupture, causing ALOT of abdominal pain.



From what I understand, the pain should subside after a few days, and she should be back to normal. This does not have any affect on her ability to be pregnant in the future.



This is my understanding. maybe some wonderful women from the board can come along and articulate what I said better, fix my mistakes, or give you more info. You sound like a good friend to be so concerned about your roomate! Take care!  
livertrans

05/18/06
  My niece had functional ovarian cysts that ruptured, all the time.  She had two children and thought she was pregnant again about a year after having her tubes tied.  Obviously did not cause her problems after.  A lot of pain with the cysts however.  
fungirl

05/18/06
  When a cyst ruptures, she may feel some pain for a couple of hours.  I do not think it should worry her, or the doctor would have said somethind.  Hope she gets feeling better soon.  


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Thank you, again!! I hope I didn't come across as "challenging" you in your interpretation of my US results. I didn't mean to & apologize if I did. I am just grateful that somebody(you) took a few minutes to calm my nerves.

As you can probably tell, I am a worried, freaked-out spaz. With my family history of breast cancer   (both relatives died young...one in her 30's, the other in her late 40's/early 50's) and with me never having any GYN issues prior to this(incl irregular bleeding), knowing something is wrong with me and, yet, not knowing if it's (the start of something) serious scares me. I already have a husband with leukemia. Last thing I need is me sick, too, and our 10-yr-old daughter worrying about both parents. Anyways, thanks again for "listening".
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You've said that no one has responded to your posts, but I had responded to one of your prior post, if you get a chance to see it...  I wrote quite a bit so maybe something in there will be useful.
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Hi, Curls! Thank you for your responding to my "original" post. When I said I didn't get any responses to my original post, I was talking about the (second)one with the verbatim results from my sonohystogram, not the very first post titled "Ovarian cyst, Uterine Polyp, and Free Fluid". That's the one that you responded to.

Anyways, believe me, I do appreciate your feedback as well. That's what prompted me to get a copy of the US results so I could post them on here and see what others think. Again, thank you!
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Tell me what you think:

Up until all my gyn problems started in April, my menstrual cycles have ALWAYS been regular...including while on the BCP(although I'm not taking them anymore), after having my daughter, and even after losing 25+lbs. The periods always came every 28 days and last 5-7, where the first 1-3 days were heavy and then the remaining days gradually got lighter until it stopped. I've never had any spotting in-between periods(including when on the Pill), never missed a period(except for when I was pregnant), and have never experienced irregular bleeding or cycles.

Then I start having this intermenstrual(between-periods) bleeding in April and it has occurred every month since then. Like clockwork, it starts exactly 10 days after my "normal" period ends, has been equivalent(in amount) to the last 2-3 days of a "normal" period(meaning it's moderate in amt and requires me to wear a pad and change it a couple times/day), and lasts about 4 days each month.  

Fast forward to July 1st: that day, I get my "normal" period and it starts out like any other "normal" period. But then, after 2 days of the heavy bleeding, the period just COMPLETELY stops. The flow didn't get lighter in amt or color....just went from heavy bleeding one day to waking up the next and having nothing. Not even a pin-size drop of blood!!. (I did call the doctor about this last week and that's when she decided I needed to have the ultrasound done).

Anyways, so now it's been 10+ days since that abnormal "normal" period ended & since I've had the ultrasound done(which showed the "growth" on my uterus & cyst on my ovary). I still haven't had any intermenstrual bleeding, but I've had lots of intermittant dull pain & cramping that starts in my right lower pelvic area and spreads across to the left side. In fact, the other night I was so uncomfortable that I had a hard time trying to fall asleep. I don't know if it was pelvic pain or feeling extremely(!!!!) bloated. Do you think I need to call the doctor back regarding this or just monitor the situation and wait to have the D&C/hysteroscopy done next month?

Thanks for any input!
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I don't have experience with fibroids, but based on my reading (internet searches), fibroids cause the symptoms you describe. If it were me that was cramping or bloating, I would monitor. If anything got worse, I would call the dr.
(((Raynbow
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A cyst could cause those exact symptoms too.  I don't think a polyp would cause that much irregularity/heaviness.  I had issues similar to that with the cyst (& polyp) and not since.  Although every time I get an internal exam at the gyno I get spotting for a few days.  FYI, the 10-11 days is when ovulation happens.  

I don't remember if you are going to an gyno oncologist to double check this, but I would at least run it by the staff of an oncologist's office to see if they want to bring you in.  

While the irregularities are annoying, and the risk of ovca is very small, it's not something to wait and watch on.  I don't see any of the indicators that I recognize but it's not just simple cysts either, so that's why I suggested asking an oncologist's office to see if there is a risk.
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A half-inch cyst or fibroid can cause that much trouble?? I would have thought more the fibroid than the cyst since it's inside the uterus, where the blood comes from. What about endometriosis? That can cause the irregularities too....
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Thanks, guys, for continuing to give me feedback. I know this sounds wierd, but I can't wait to get the D&C/hysteroscopy/polyp resection overwith. This waiting game is pure torture!! Then again, I still don't know when I'm having the surgery and, of course, I have to wait to get the repeat ultrasound done in 3 months to know if I'm all clear.

I know this next question is also going to sound wierd, but wouldn't you feel like you're going behind your doctor's back if you consulted with a gyn-oncologist w/o your primary gyn doctor knowing? I do trust my GYN and feel she's telling me everything. I'm just very scared & worried that there might be more going on that she can't answer at this point until she does the surgery &/or repeat ultrasound. Also, I am planning to ask her to add the CA-125 test added to my pre-op blood work. I know the test is not 100% reliable(or even close) in a premenopausal female, but at least I'll get an idea what my baseline count is &/or if it's abnormal. What do you think?
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A good doctor doesn't have a problem with a 2nd opinion or 3rd and would encourage it especially if a gyn-oncologist feels there's reason.  They can even be curious to learn more by your going elsewhere and giving them feedback.  A doctor who has a problem with it may have an emotional reaction, but that's their issue.  It's your life and well being and it's up to you to take care of yourself.  I'm glad you are considering it because the 3 month wait for follow up US scares me.  She may very good & telling you everything she knows, but she's not in the gyn-oncology field.  If you feel like you should let her know, then there's no harm in calling the office and telling her, or couch it as a question on what she thinks of you doing it.  You can even ask her for a referral which can be a good source.  (My original gyno gave me a referral to someone she was in a regular medical relationship with and I got a very odd sense so I found someone independent instead.)  The D&C is in a different location and won't tell her what you need to know about the one risk factor here, ovca.  (At least that's what my 1st gyno told me.)  A baseline CA-125 is a good idea.  (However, it's a useless test unless there turns out to be ovca,  detected though surgery.  And an elevated result can play with your mind.)  I did appreciate the advice I got from my (2nd, much better) gyno to have it done before the surgery - just in case.  It's natural when there's a procedure upcoming to get anxious to get it done.  You can say to yourself, it's not big deal, but with all those pictures in your head, it just sticks around in the forefront for all of us.  

Mostly though, please take care of yourself without worrying about whether you are going to upset anyone.  They don't have to live with the consequences.
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I agree with Curls. I haven't seen a gyn-onc, but I'm thinking about it this time. The gyn that did my last 2 surgeries has moved about 45min away. I can see a different one in the same group, but I feel like since he had another doc helping him during lap from that group, then the whole spillage thing and cervix puncture shouldn't have happened....I think I'm right by saying a gyn-onc is more specialized in the delicacy of these operations. My friend/neighbor is in his 3rd year surgery residency program and teased me that if I had a "real" surgeon instead of a gyno doing my surgery then I wouldn't have had these things happen (infection, puncture, spillage). Anyhow, it's not about me -it's about you....I think it would be a good idea for both of us to see an onc just to see what they have to say about these things. I personally would like one to know about me because I think they could be honest with me about the risk of developing pseudomyxoma peritonei from the mucinous spillage. Maybe they could also tell me why I'm suddenly having ovarian problems. Hope you get the answers you're looking for too! There is nothing wrong with being in charge of YOUR own health. It is normal to want a 2nd opinion.
((( Raynbow
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Look...YOU HAVE ONE CHANCE TO GET IT RIGHT THE FIRST TIME.....see a gyn/oncologist....that is who you want by your side in surgery.....plain and simple.....and any doc who gets their feelings hurt is in the wrong profession....they are supposed to want the best for their patients.....anything else is unacceptable.
Peace.
dian
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Hey there, diane, I dunno if you remember me from last year or not, but anyway, I am leaning towards (finally) taking your advice on the onc thing. I got a f/u u/s on Tuesday and should know by next Thursday if things are growing or not, then I'll ask to be referred. You are adament about this kind of thing and I respect your passion and your opinions!
Take Care, (and Peace 2 u 2)
((( Raynbow
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I found out today that my surgery is scheduled for August 23rd. A month-and-a-half away!! I didn't think I'd have to wait that long. Apparently the doctor's schedule is already booked up to that point, as is the OR at the hospital(and, since I work at the hospital, I'd prefer to have the surgery done there vs the outpatient/ambulatory surgery center). I just hope I don't have any irregular bleeding at surgery time because they told me that they can't do the procedure if I am. Good luck on that one!!  With the way things are going, and this month they have gotten stranger & more irregular, who's to say if I will or won't be bleeding.

Anyways, I also wanted to let you gals know that I asked the surgery scheduler to include the      CA-125 on my list of pre-op lab work. She seemed surprised & caught off-guard when I mentioned it, but said she'd add it on. Will the insurance company pay for it if the doctor didn't order it? If not, does anybody have an idea of how much the test costs?

Thanks again for all your supportive comments. They truly do help!!
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I'm glad you're on track. Best wishes!
((( Raynbow
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Ok, I am getting very confused & concerned!!

As mentioned in above postings, I have been experiencing intermenstrual(between-periods) bleeding every month since April. Like clockwork, it has started exactly 10 days after my "normal" period ended, has been equivalent(in amount) to the last 2-3 days of a "normal" period(meaning it's moderate in amt and requires me to wear a pad and change it a couple times/day), and lasts about 4 days each month. During this time, my regular(normal) periods had been normal, in length & amount.

Fast-forward to this month. I got my regular period on July 1st.......and it was anything but normal. The period lasted 2 days, with both days consisting of heavy bleeding before it abruptly, unexpectedly, and abnormally stopped. So, considering this info and the pattern of my menstrual cycles lately, that means the intermenstrual bleeding should've started around 7/13, give or take a day. Also, because the sonohystogram showed a uterine polyp and cyst on my right ovary, the doctor said I would continue to have the intermenstrual bleeding until the polyp was removed(which won't occur until 8/23).

Well it is now 7/22, 19 days(!!!!) since my last regular, but abnormal, period ended and I still have not had any intermenstrual bleeding. Isn't this odd, considering the polyp(and possibly the cyst) is still there? This last week, I have been experiencing ALOT of lower pelvic pain, cramping(both menstrual & stomach-ache), sharp pains on my left lower pelvic area, diarrhea(that just came out of nowhere), and occassional thick, clear vaginal discharge. But not a speck of blood in sight! What the heck is going on with me? Should I be getting worried that something else is going on or what is already wrong is getting worse? Should I be calling the doctor again? The stress of worrying is killing me.
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