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Pelvis » Female Pelvis (Gynecology)
Left tubo-ovarian abscess
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Presentation A 36 year old woman presented to the ER with sharp left sided pelvic pain and dyspareunia.
Caption: Transverse transvaginal scan
Description: The uterus appears normal. A large cystic mass is seen in the left adnexa which demonstrates homogeneous, low-level internal echoes. The left ovary is not visualized separate from this mass.
Caption: Sagittal image of the left adnexal mass
Description: The cystic mass has a smooth wall except for one loculated area that exhibits thick irregular walls. The medial wall of the locule demonstrated blood flow on Doppler [not shown here].
Caption: Transverse image of the cystic mass
Description: The complex adnexal cyst is noted again, demonstrating low level internal echoes. A thin septum is seen extending from the wall. The mass appears to be contained within the left ovary (compressed ovarian tissue is seen around the entire periphery).
Caption: Transverse scan demonstrating both adnexae
Description: The right ovary is seen in this image and exhibits a small cyst with septations.
Caption: Transverse image of the right ovary
Description: The right ovary in a different plane shows multiple cystic areas, some of which are septated. The rest of the ovarian tissue appears somewhat inhomogenous.
Differential Diagnosis Left tubo-ovarian abscess, left ovarian malignancy, post-inflammatory changes in the right ovary
Final Diagnosis Left tubo-ovarian abscess
Follow Up This patient went to surgery. A 12 cm left tubo-ovarian abscess which showed evidence of torsion was removed. The cyst in the right ovary appeared to be a benign cyst.
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