Fig. 12  Streak gonads. In a 23-year-old female, uterine hypoplasia (*) is demonstrated on the sagittal T2WI (a). Normal ovaries are not identified. A bandlike soft tissue

structure (arrow) adjacent to the external iliac vessel presents a left streak gonad (b)

Differential diagnosis  Differential diagnosis of a unilateral missing ovary includes ectopic ovary and atrophy resulting­ from adnexal torsion. Mullerian duct anomalies support congenital etiology and warrant search along the psoas muscle outside the pelvis.

3\ Ovarian Transposition

Surgical transposition of the ovaries is accomplished before therapeutic irradiation of the pelvis in women to preserve ovarian function. Ovaries, supportive ligaments, and their vascular supply are surgically mobilized outside the pelvis, most commonly laterally to the paracolic gutters anterior of the psoas muscles (Wo and Viswanathan 2009).

Other sites of transposition are the lower paracolic gutters close to the iliac fossa. Lateral transposition is performed in patients with cervical cancer, vaginal cancer, pelvic sarcoma, and Hodgkin disease. Medial transposition refers to attachment of the ovaries to the surface of the uterus (Kier and Chambers 1989; Bashist and Freidman 1989). Surgical clips are typically affixed to each ovary to mark its location.

Imaging findings

Transposed ovaries can be identified by their characteristic morphologic feature of follicles that undergo follicular maturation. Metallic clips help to identify the ovaries on CT (Fig. 14) (Bashist and Freidman 1989). Furthermore, following the ovarian vessels downwards from the mid-lumbar region aids in identifying the ovaries (Lee et al. 2003).

Fig. 13  Ovarian maldescent associated with uterine malformation. Coronal (a, b) and sagittal (c, d) T2WI. The left ovary is in normal position adjacent to the unicornuate uterus (arrowhead) (a, c). The left ovary is in atypical

high position anterior to the psoas muscle (d). It contains multiple peripheral follicles (b) and displays an atypical elongated shape (arrow) (d)

Ovarian vessels in lateral transposition deviate laterally near the iliac fossa instead of coursing inferiorly (Saksouk and Johnson 2004). Transposed ovaries should not be misdiagnosed as peritoneal implants. Medical history and metallic surgical clip markings in CT will facilitate dif-

ferentiation, as well as meticulous analysis of ovarian morphology including ovarian follicles on T2WI (Sella et al. 2005). Identification of featureless and small atrophic ovaries is feasible due to the surgical clips in CT, but it may be difficult in MRI.

Fig. 14  Surgical transposition. Transaxial CT after transposition of the ovary (a) and after radiation therapy (b). During endoscopical transposition, the left ovary was marked by a clip (arrow). In the follow-up, the cystic and

Differential diagnosis  Familiarity with history of ovarian transposition is crucial to establish the correct diagnosis. The differential diagnosis includes mucocele of appendix, peritoneal implants, colonic masses, lymphoceles, and lymph node metastases.

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