Presentation
Pain and mass sensation in the lower abdomen about two months ago, without any complaints of fever or previous abdominal or pelvic infections.
Patient Data
A high T2, low T1 signal cystic lesion was depicted in midline pelvic cavity anterior to and separate from uterus and both ovaries, containing a serpiginous low T2 signal floating structure. The lesion shows rim enhancement on post-contrast images.
The above features mostly resemble an abscess cavity besides serpiginous floating contents.
A dense serpiginous structure is depicted on the right side of pelvic cavity consistent with a retained surgical sponge.
Case Discussion
The patient was referred to our tertiary center due to a palpable pelvic mass. Sarcoma was suggested as the first diagnosis based on the initial pelvic MRI findings in another center, and the operation was scheduled. On routine preoperative ultrasound exam, a large hypoechoic pelvic lesion containing internal echogenic structures with marked posterior acoustic shadowing was detected. Plain abdominopelvic X-ray was done to delineate better the characteristics of these echogenic structures, which proved to be a serpiginous opaque structure, highly suggestive of a retained surgical sponge. In the second-look evaluation of the MR images, a large cystic lesion was noted in the pelvic cavity separate from bilateral normal ovaries. The lesion showed the radiologic features of an abscess but contains linear serpiginous structure, thereby, consistent with a retained surgical sponge. In a retrograde review of the patient‘s history, a previous abdominal surgery three years ago was revealed. Considering the diagnosis of gossypiboma, the patient underwent an uncomplicated surgery, and an abscess cavity containing retained surgical sponge about the patient’s previous operation was found.