Home WIOTM Case of the Month July – A female with an acute onset of severe pain in the lower abdomen

Case of the Month July – A female with an acute onset of severe pain in the lower abdomen

by Admin

A female with an acute onset of severe pain in the lower abdomen

Dr. Serghei Puiu, Dr, PhD

Department of Radiology and Imaging, State University of Medicine and Pharmacy “Nicoale Testemitanu”, Chisinau, Republic of Moldova

Corresponding author: Serghei Puiu
Email: puiusv@yahoo.com

Clinical History:

A 47-year-old lady was referred to our department for a second opinion before surgery regarding an ovarian mass suspect of an ovarian tumour. She had an acute onset of severe pain in the lower right abdominal quadrant one week previously, which disappeared spontaneously. When she presented in our department, she had no pain or fever. Blood tests, including tumour markers, were normal.

Transabdominal and transvaginal ultrasound scans were performed. They showed an enlarged, but well-defined right ovary, appearing as a mass (Fig. 1-2). The stroma was heterogeneous due to edema displacing the follicles peripherally (Fig. 3). An echogenic thickened fallopian tube seemed to wrap the enlarged ovary (Fig. 4 a-c). The ovarian arterial and venous flow was preserved (Fig. 5 a-b). A small fluid collection in the Douglas pouch and around the ovary was seen. There was a slight pain on transducer touch.

Figure 1. Enlarged right ovary mimicking a solid adnexal mass.
Figure 2. Enlargement (up to 139 cm3) of the right ovary.
Figure 3. Peripherally located ovarian follicles, displaced by the ovarian stromal edema. Note the heterogeneous appearance of the ovarian stroma.
Figures 4 a-c. Thickened fallopian tube surrounding the enlarged ovarian mass. Small anechoic fluid collection around the ovary. Compare the swollen right tube (thick arrow) and normal appearance of the left tube (thin arrow).
Figures 5 a-b. Present ovarian arterial and venous flow, showing typical Doppler patterns.
Figure 6 a-c. Normal appearance and vascular flow of the right ovary two months later. The right fallopian tube is difficult to visualize.

View the July Case below, answer the question and then click check >

0 comment
1

You may also like

Leave a Comment

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More

Translate »