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🩺 PELVIC ULTRASOUND: Differentiating Para-ovarian Cyst and Hydrosalpinx

🔍 On pelvic ultrasound, not every cystic structure near the o***y is ovarian in origin. Recognizing key sonographic signs allows accurate differentiation of cystic adnexal pathologies and supports correct diagnosis.

This is a classic ultrasound teaching illustration demonstrating how to differentiate a para-ovarian / para-tubal cyst from hydrosalpinx using key sonographic features.

💬 Below is a clear, professional breakdown 👇

🔻 UPPER IMAGES – PARA-OVARIAN / PARA-TUBAL CYST

Ultrasound: (A)

🔸Thin-walled, anechoic, unilocular cyst
🔸Demonstrates the Split Sign
➜ With gentle probe pressure, the cyst separates from the o***y, confirming an extra-ovarian origin

Real View:

🔸Cyst located adjacent to the o***y
🔸Commonly arises from:
• Para-ovarian structures
• Para-tubal structures
• Broad ligament

✅ Key Point:
Split sign = not ovarian in origin

🔻 LOWER IMAGES – HYDROSALPINX

Ultrasound: (A)

🔸Elongated, tubular, cystic structure
🔸Shows the Cogwheel / Beak Sign
🔸Caused by thickened and flattened endosalpingeal folds (plicae)

Real View:

🔸Distended fallopian tube filled with fluid
🔸Ovary visualized separately

✅ Key Point:
Cogwheel / Beak sign = dilated fallopian tube

🩺 Why This Is Important

🔸Helps prevent misdiagnosis as an ovarian cyst
🔸Guides appropriate clinical and surgical management
🔸Essential for accurate gynecologic and pelvic ultrasound reporting

📌 Quick Summary

▪️Presence of the Split sign indicates a para-ovarian / para-tubal cyst
▪️Presence of the Cogwheel / Beak sign indicates hydrosalpinx

📚 Clinical Importance

Proper recognition of these ultrasound signs is essential for:

▪️Accurate reporting
▪️Correct gynecological diagnosis
▪️Appropriate patient management

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Those two “holes” on the lower back are normal anatomical features called back dimples.

🔻They are known as:

🔸Dimples of Venus (in females)
🔸Dimples of Apollo (in males)

🔻What they mean

These dimples are caused by a natural ligament attachment where the skin connects to the posterior superior iliac spine (PSIS) — part of the pelvic bone. Because the skin is tethered there, it creates a small indentation.

🔻Important facts

✅ Completely normal
✅ Genetic (you’re born with them)
❌ Not a disease or deformity
❌ Not caused by exercise (though fitness can make them more visible)

🔻Why they look more visible in some people

🔸Low body fat
🔸Strong back muscles
🔸Good posture
🔸Lighting / shadows
🔸Weight loss

💬Fun fact

They’re often considered a sign of:
🔸Good pelvic structure
🔸Strong core
🔸In some cultures, attractiveness (especially in fitness models)

🔆So in short: they are just normal back dimples, nothing wrong at all.

☢️ SimpleRadiography☢️

Greetings,

I am SUFIYAN ABUBAKAR, proud to represent Nigeria on my journey through academia. Having graduated with a degree in Radiography from Integral University in Lucknow, Uttar Pradesh, India, I am passionate about leveraging my knowledge and skills to make a difference in the field. Join me on my exploration of radiography through my YouTube channel, (SimpleRadiography.com), and stay connected on my page under the same name. Together, let's unravel the mysteries of this fascinating domain and share our insights with the world.