When an imaging scan, such as an ultrasound, reports that ovaries are “not visualized,” it means the sonographer or radiologist could not clearly identify one or both ovaries. This is common and does not automatically signal a serious medical issue. Many factors, both non-medical and medical, can contribute to this finding.
Factors Impeding Ovarian Visualization
Non-medical factors can make ovarian visualization challenging during an imaging scan. Equipment limitations, such as older machines or lower resolution settings, may not provide clear images to locate smaller structures. The sonographer’s skill and experience also influence visualization, as identifying these organs requires precise technique and anatomical knowledge.
Patient-related factors often contribute when ovaries are not seen. A layer of adipose tissue around the abdomen or pelvis, often associated with obesity, can impede ultrasonic sound waves, making visualization difficult. Bowel gas can also obscure the view, as gas reflects sound waves, creating shadows that hide underlying structures. Additionally, ovaries can vary in position, located higher in the pelvis or tucked behind the uterus, making them harder to locate.
Underlying Medical Explanations
Beyond technical and patient-related challenges, medical conditions can explain why ovaries might not be visualized. A common reason, particularly in older women, is post-menopausal atrophy. After menopause, ovaries shrink due to decreased hormonal activity, making them smaller and harder to distinguish on ultrasound. Previous surgical procedures, such as an oophorectomy, would also explain their absence.
Congenital absence of ovaries is a rare condition where the ovaries never developed. Other pelvic structures can obscure the ovaries. Uterine fibroids, non-cancerous growths, or severe endometriosis, where uterine-like tissue grows outside the uterus, can create masses that hide the ovaries. Pelvic adhesions, bands of scar tissue that can form after surgery or infection, can also displace or surround the ovaries, making them difficult to locate.
Ovaries may also be difficult to visualize if they are very small or non-functional due to hormonal imbalances or genetic factors. While polycystic ovary syndrome (PCOS) often involves enlarged ovaries with multiple small follicles, the ovaries might be challenging to distinguish due to their structure or positioning. Ovarian torsion, where the ovary twists around its supporting ligaments, can cause swelling and alter the ovary’s position, making it difficult to identify. A study found that 20.6% of ovaries were not visualized on pelvic ultrasound, with 35.4% of those cases having benign lesions, mostly small, sub-centimeter in size.
Subsequent Steps and Evaluation
When ovaries are not visualized during an initial imaging scan, the next steps involve further evaluation. A repeat imaging scan is often recommended, sometimes utilizing a different technique. For instance, if a transabdominal ultrasound was initially performed, a transvaginal ultrasound might be used as it offers a closer view of the pelvic organs and provides more accurate images. MRI or CT scans may also be ordered, as these modalities offer more detailed pelvic anatomy.
Prior to follow-up imaging, preparations may be advised, such as ensuring a full bladder for transabdominal scans, which can help displace bowel gas and improve visualization. Blood tests may also be part of the evaluation to check hormone levels, such as Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and estrogen. These hormone levels can provide clues, particularly in cases of suspected menopause or other hormonal imbalances.
The interpreting physician will consider imaging findings with a patient’s symptoms, medical history, and other clinical information. In many situations, especially in post-menopausal women, non-visualization of ovaries is considered a normal change, and no further action is needed. However, if there are concerning symptoms or other indicators, further investigation may be necessary to rule out or confirm underlying conditions. The absence of visualization on ultrasound is highly predictive of a lack of ovarian abnormality on short-term follow-up, and advanced imaging like MRI often adds little additional information, with a theoretical risk of detecting ovarian carcinoma ranging from 0 to 1.3%.