“37 years old female, had a normal delivery 4 months ago. During pregnancy had right sided mild hydro-nephrosis which resolved after child birth. No past history of abdominal/pelvic surgery. Now presented with right iliac fossa pain for 2 days. RIF was tender but no definite palpable lump. Blood tests normal esp WBC/ESR. Her G.P. thought of Renal stone & asked for Ultrasound. When I did the U.S, the kidneys were normal but there was a vascular & tender lesion in the RIF. After discussing with the G.P, I did a 3 phase CT scan.
Following are some relevant images:
1)Doppler US of RIF
2)Axial, Coronal & Sagittal CT images of Abdo/Pelvis.
Can you identify the pelvic organs & the pathology ? ”
Its unfair to wait too long.
US showed vascular mass of 4x5cm diameter in the RIF. All the blood
path including the pregnancy test were normal.
CT showed part of the appendix & terminal ileum. They were normal.
Uterus is shifted to the right towards the RIF & appears slightly
twisted. There is a cauliflower shaped mass( as identified by Eddie)
on the right side of the uterus which is more anterior owing the
“twist” & is vascular. It is the swollen right ovary which showed
patchy density. On the left side of this, there is a cyst (6-7cm
diameter). In between the ovary & the cyst, a little fluid is seen in
the CT. The cyst is arising from the right ovary. This indicates that
the right ovary is a complicated ovary.
Because the uterus & right ovary appeared twisted & the swollen ovary
is vascular, I thought that it may be “Acute torsion of inflamed
dermoid cyst”.(About 50% of torsion occurs in ovaries with some lesion
& 50% of this are due to Dermoid cysts).
The posterior lesion noted by Eddie is a partly calcified Fibroid of
abt 7-8 cm diameter.
Patient underwent emergency surgery & the Gynecologist thought that it
is “Torsion of right ovarian Tumor”- “Borderline tumor”
The Path report:- Sero-mucinous tumor of ovary.
I have provided an annotated(CT) answer with numbers. Please zoom to
read the letters.
2=Right Ov Cyst
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the medical knowledge you gathered so far in your life.