7–11 October 2007, Florence, Italy Poster abstracts P43.11 Ultrasound characteristics of hydrosalpinx E. Domali 1 , C. Van Holsbeke 1 , T. Van Den Bosch 1 , D. Jurkovic 2 , A. Testa 3 , L. Valentin 4 , D. Timmerman 1 1 Leuven Hospital, Belgium, 2 London Hospital, United Kingdom, 3 Rome Hospital, Italy, 4 Malmo Hospital, Sweden Objectives: To describe the ultrasound findings of hydrosalpinx as well as to identify the main features that could help distinguish between hydrosalpinx and other adnexal masses. Methods: Based on the histological diagnosis of hydrosalpinx, 30 women (23 premenopausal and 7 postmenopausal) have been included in the study. These women with at least one persistent adnexal mass preoperatively underwent transvaginal gray-scale and color Doppler ultrasound examination, using standardized terms and definitions. The ultrasound findings as well as data from the personal history have been analyzed retrospectively. Results: The masses observed during the ultrasound examination were smooth tubular structures, with mean maximum diameter 63.0 ± 7.25 mm, giving the impression that they originate from the tube (73%). 87% of the masses (26/30) were unilocular, anechoic, poorly vascularized formations (67% without blood flow; 23% with minimal blood flow in the lesion; 7% moderately strong flow; and 3% highly vascularized lesion). The internal cyst wall was regular in 63.3% while only one papillary projection (6 × 5 × 5 mm) was identified in one mass. The main ultrasound finding was the presence of an incomplete septum in 18 of the 30 masses (60%), while septa have been observed in 27% of the masses. Based on the data collected from the personal history of the women, 70% previously underwent an abdominal operation, indicating a possible close relationship between operation and the subsequent formation of hydrosalpinx. Conclusions: We conclude that the sonographic appearance of incomplete septum in an anechoic mass with smooth tubular shape and poor vascularization facilitates discrimination between hydrosalpinx and other adnexal masses. Additionally, a personal history of previous abdominal operations further supports the preoperative diagnosis of hydrosalpinx. P43.12 Adnexal torsion at gestational limits of viability: is Doppler ultrasound helpful? M. O. Thompson , E. Hawkins Queen’s Hospital Romford, United Kingdom Background: Accurate preoperative diagnosis of adnexal torsion is a clinical challenge, even though early confirmation is desirable to permit organ salvage. Physiological changes in pregnancy such as leucocytosis and the upward displacement of the ovaries are some known limitations to early diagnosis. Added management dilemmas present at the legal limits of fetal viability when for surgical treatment, the indications have to be compelling. Case Presentation: We present the case of a 30-year-old primigravida admitted at 23 weeks, gestation with severe lower abdominal pain, pyrexia, nausea and vomiting. The pain radiated from the costovertebral angle to the right iliac fossa. Vomiting was intermittent. Differential diagnoses included urinary tract infection, urolithiasis and appendicitis. Laboratory studies were typically unhelpful. Abdominal ultrasound scan showed a simple right luteal cyst measuring 4.6 × 3.9 × 5.5 cm adjacent to a normal looking ovary. The ascending branches of the uterine and ovarian vessels demonstrated both arterial and venous flow. Arterial PI measured 0.68 and 0.78 respectively. No inflammatory bowel mass or other abnormality was seen. A decision was taken to operate after giving prophylactic steroids for fetal lung maturity. A mini-laparotomy and ovarian cystectomy with de-torsion of the ipsilateral ovary was performed under a short acting anesthetic after the course of prophylactic steroids. The diagnosis of incomplete torsion of the ovarian pedicle and normalcy of the appendix were confirmed at surgery. There was no evidence of organ necrosis. There were no post-operative complications and pregnancy continues. Conclusions: Adnexal torsion presented as an acute abdominal emergency at 23 weeks, gestation. High-resolution ultrasound and colour Doppler imaging confirmed organ viability. This helped with triaging, and pre-operative counseling regarding the mode and extent of surgery. P43.13 Ultrasound-guided aspiration of ovarian cysts: does it still have a role in clinical management? D. Dordoni, S. Corini, G. Donarini, F. Meani, C. Stegher Universit ` a degli studi di Brescia, Italy Objectives: Despite the diagnostic and therapeutic roles of ultrasound-guided aspiration having been evaluated, no definitive conclusions have been achieved in the recent literature and its application in clinical practice differ widely among the Authors. The aim of this study is to understand the possible actual role of ultrasound-guided aspiration of ovarian cysts in the clinical practice. Methods: During last year in our gynecology ultrasound unit, 50 patients carrying sonographically benign ovarian cyst and negative tumor markers, underwent ultrasound-guided aspiration due to one or more of the following indications: – cyst persistence, – pelvic pain, – diameter of the cyst between 40 and 80 mm. Needle aspiration of the cysts has been performed transvaginally under continuous ultrasound guidance, using a 23 cm 20-G needle. All specimens collected have been sent for cytological examination. All patients underwent a follow-up ultrasound evaluation from 4 to 6 months after the procedure to determine a possible cyst reappearance. Results: Average age in the study population was 46 (range, 19 to 71) years; 26 patients were pre-menopausal and 24 were post- menopausal; among the latter one taking Tamoxifen and one HRT; 22 never used any therapy. Fifteen cysts with diameter of 4 cm and 35 with diameter 5 to 8 cm were aspirated. Cytologic examinations of fluids showed: 45 negative specimens, four cases of unsatisfactory specimens and in one case cytonuclear irregularity. In this last case, the patient underwent ovariectomy. Definitive histology was negative. Six patients were lost at follow-up. Among the remaining 44 patients, 25 showed recurrence and 19 did not develop further ovarian cysts. No adverse effects were observed in all patients. Conclusions: Ultrasound-guided aspiration of ovarian cysts should be taken in to consideration as an alternative therapeutic option only in case of symptomatic and/or persistent cyst in pre-menopausal women or in post-menopausal patients for cytologic evaluation before considering a surgical intervention. P43.14 Ultrasonography in the diagnosis and follow-up of patients with abdominopelvic tuberculosis R. R. Panlilio-Vitriolo UP-PGH Medical Center, Philippines Objectives: A definitive diagnosis of abdominopelvic tuberculosis requires bacteriological or histological confirmation. Endometrial biopsy has a false negative rate of 50%. With laparotomy, there is danger of bowel perforation and fistula formation due to the possibility of adherence of bowels to the abdominal wall. A reliable non-operative means of establishing the diagnosis of abdominopelvic tuberculosis can prevent futile and possibly hazardous surgery. The purpose of this study is to describe our experience with pelvic tuberculosis with emphasis on ultrasound as a diagnostic and monitoring tool. Methods: Twenty-eight patients with a clinical diagnosis of abdominopelvic tuberculosis underwent transabdominal and Ultrasound in Obstetrics & Gynecology 2007; 30: 547–653 617