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Radiological illustration of spontaneous ovarian hyperstimulation syndrome.

Mittal K, Koticha R, Dey AK, Anandpara K, Agrawal R, Sarvothaman MP, Thakkar H - Pol J Radiol (2015)

Bottom Line: The patient had no significant medical and surgical history.This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically.Biochemical markers will confirm the radiological diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India.

ABSTRACT

Background: The role of radiology is of utmost importance not only in diagnosing s-OHSS but also in ruling out other cystic ovarian diseases and to determine the underlying etiology and course of the disease. We presented a radiological algorithm for diagnosing the various causes of s-OHSS.

Case report: A 26-year-old female, gravida one was referred to radiology department with history of lower abdominal pain, nausea and vomiting since 2 days which was gradual in onset and progression. The patient had no significant medical and surgical history.

Conclusions: This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically. Biochemical markers will confirm the radiological diagnosis.

No MeSH data available.


Related in: MedlinePlus

Radiological algorithm for diagnosing the various causes of s-OHSS.
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f11-poljradiol-80-217: Radiological algorithm for diagnosing the various causes of s-OHSS.

Mentions: Ultrasonography plays the main role not only in diagnosing OHSS but also in diagnosing its etiology. At our center, to improve the detection of s-OHSS and find the underlying trigger, we proposed a radiological algorithm (Figure 11). An underlying history of drug intake rules out the iatrogenic cause of OHSS. Then, the uterine cavity is scanned to rule out gestation or persistent gestational disease. A single live pregnancy with OHSS is labeled as Type I s-OHSS and is confirmed by normal β hCG, TSH, and LH levels, and raised estradiol levels. Such patients should undergo DNA analysis for a mutated FSH receptor. Multiple live pregnancies cause a substantial increase in β hCG levels which in turn leads to OHSS. Abnormal multiple scattered cystic spaces with or without fetal parts should raise the suspicion of hydatidiform mole or persistent gestational trophoblastic disease, which is confirmed by exceptionally elevated β hCG levels. This is classified as Type 2 s-OHSS because OHSS is triggered by raised β hCG levels. Subsequently, if the patient is non-gravid, the thyroid gland is evaluated in the same setting to rule out thyroiditis as the underlying cause of OHSS. Thyroiditis-induced OHSS, also called Type 3 OHSS, is confirmed by raised TSH and normal to decreased T4 and T3 levels. A triple hormonal assay of LH, FSH, and β hCG is carried out if all the above mentioned investigations are negative. Raised values of any hormone will raise the suspicion of a hormone-secreting tumor. Multimodality imaging in the form of brain MRI and CECT of the abdomen and chest is performed. Generally, brain MRI is the preferred non-ionizing modality over CECT of the abdomen and pelvis. Brain MRI may reveal a sellar, suprasellar or pineal gland mass, which is commonly a pituitary adenoma, and is confirmed by raised LH and FSH levels, whereas raised β hCG levels with an intracranial mass lesion support the diagnosis of a β hCG-secreting tumor. Chest and abdomen CT is advised to rule out an ectopic LH/FSH-secreting tumor or extragonadal β hCG-secreting tumor, as in our case. Thus β hCG-secreting tumors are classified as Type 2 s-OHSS, and LH/FSH-secreting tumors are labeled as Type 4 s-OHSS. Further investigations, like CA-125, pelvic MRI, laparoscopy/biopsy can be done for inconclusive cases.


Radiological illustration of spontaneous ovarian hyperstimulation syndrome.

Mittal K, Koticha R, Dey AK, Anandpara K, Agrawal R, Sarvothaman MP, Thakkar H - Pol J Radiol (2015)

Radiological algorithm for diagnosing the various causes of s-OHSS.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4418209&req=5

f11-poljradiol-80-217: Radiological algorithm for diagnosing the various causes of s-OHSS.
Mentions: Ultrasonography plays the main role not only in diagnosing OHSS but also in diagnosing its etiology. At our center, to improve the detection of s-OHSS and find the underlying trigger, we proposed a radiological algorithm (Figure 11). An underlying history of drug intake rules out the iatrogenic cause of OHSS. Then, the uterine cavity is scanned to rule out gestation or persistent gestational disease. A single live pregnancy with OHSS is labeled as Type I s-OHSS and is confirmed by normal β hCG, TSH, and LH levels, and raised estradiol levels. Such patients should undergo DNA analysis for a mutated FSH receptor. Multiple live pregnancies cause a substantial increase in β hCG levels which in turn leads to OHSS. Abnormal multiple scattered cystic spaces with or without fetal parts should raise the suspicion of hydatidiform mole or persistent gestational trophoblastic disease, which is confirmed by exceptionally elevated β hCG levels. This is classified as Type 2 s-OHSS because OHSS is triggered by raised β hCG levels. Subsequently, if the patient is non-gravid, the thyroid gland is evaluated in the same setting to rule out thyroiditis as the underlying cause of OHSS. Thyroiditis-induced OHSS, also called Type 3 OHSS, is confirmed by raised TSH and normal to decreased T4 and T3 levels. A triple hormonal assay of LH, FSH, and β hCG is carried out if all the above mentioned investigations are negative. Raised values of any hormone will raise the suspicion of a hormone-secreting tumor. Multimodality imaging in the form of brain MRI and CECT of the abdomen and chest is performed. Generally, brain MRI is the preferred non-ionizing modality over CECT of the abdomen and pelvis. Brain MRI may reveal a sellar, suprasellar or pineal gland mass, which is commonly a pituitary adenoma, and is confirmed by raised LH and FSH levels, whereas raised β hCG levels with an intracranial mass lesion support the diagnosis of a β hCG-secreting tumor. Chest and abdomen CT is advised to rule out an ectopic LH/FSH-secreting tumor or extragonadal β hCG-secreting tumor, as in our case. Thus β hCG-secreting tumors are classified as Type 2 s-OHSS, and LH/FSH-secreting tumors are labeled as Type 4 s-OHSS. Further investigations, like CA-125, pelvic MRI, laparoscopy/biopsy can be done for inconclusive cases.

Bottom Line: The patient had no significant medical and surgical history.This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically.Biochemical markers will confirm the radiological diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India.

ABSTRACT

Background: The role of radiology is of utmost importance not only in diagnosing s-OHSS but also in ruling out other cystic ovarian diseases and to determine the underlying etiology and course of the disease. We presented a radiological algorithm for diagnosing the various causes of s-OHSS.

Case report: A 26-year-old female, gravida one was referred to radiology department with history of lower abdominal pain, nausea and vomiting since 2 days which was gradual in onset and progression. The patient had no significant medical and surgical history.

Conclusions: This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically. Biochemical markers will confirm the radiological diagnosis.

No MeSH data available.


Related in: MedlinePlus