US of the ovary and adnexa: to worry or not to worry?

Ultrasonography (US) is typically the first study to be requested in patients with clinical findings that may suggest pelvic disease. The evaluation of adnexal masses is a common component of the sonologist's workload, and US has been shown to be accurate for both detecting and characterizing these masses, most of which are either insignificant or benign and therefore require little or no follow-up. Recognition of the most common benign ovarian and extraovarian adnexal masses should help avoid additional or unnecessary imaging. US features that suggest malignancy include thick septations, vascularized solid components, or areas of focal wall thickening, and identifying these features will result in timely management. Indeterminate-appearing masses demonstrate atypical features and cannot easily be classified as definitely either benign or malignant. Proper reporting and management recommendations serve to alleviate both patient anxiety and physician misinterpretation. Knowledge of these recommendations and of the characteristic US features of benign, malignant, and indeterminate adnexal masses can serve as important guidelines for patient management.