Presentation
7/40 pregnant, conceived following IVF therapy. Acute lower abdominal pain.
Patient Data
Both ovaries are enlarged, reaching >10 cm in greatest dimension on the right side. There are multiple peripheral cystic follicles, and central echogenic stroma. On other images, a small volume of pelvic free fluid was noted, as well as a twin intra-uterine pregnancy. The appendix was not clearly identified.
The enlarged ovaries are a sign of ovarian hyperstimulation syndrome and may explain the acute presentation. However, due to concern regarding the possibility of other acute diagnoses such as appendicitis, an MRI was arranged.
MRI confirms very enlarged ovaries, with the right placed superoanterior to the uterus and being larger than the left. Multiple peripheral thick-walled follicles are present. There is free fluid in the pelvis, including a small blood-fluid level. Twin gestation sacs are seen in the uterus. The appendix is not clearly identified, but there is no inflammatory process in the abdomen and pelvis, with no restricted diffusion.
Case Discussion
Ovarian hyperstimulation syndrome is a recognized complication of fertility therapy such as in-vitro fertilisation. The ultrasound and MRI studies show bilaterally enlarged ovaries with multiple follicles, and a small volume of free blood in the pelvic indicating rupture of one or more of the follicles. There were no signs of other acute inflammatory processes such as acute appendicitis. The pregnancy progressed to term with no further interventions required.