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Case contributed by Ammar Haouimi
Diagnosis almost certain


Pelvic pain in pregnant patient at 5 weeks gestation. Had a cesarian section 1 year prior.

Patient Data

Age: 40 years
Gender: Female

Well-defined cystic structure in Douglas pouch containing hyperechoic materials with intense posterior acoustic shadowing. 


Large well-circumscribed mass in Douglas pouch composed of serpiginous structures of low signal on T1 and intermediate signal on T2 with surrounding fluid collection. No pelvic lymphadenopathy or free fluid in the peritoneal cavity.

Small intrauterine gestational sac is noted.

Case Discussion

The clinical history, ultrasound and MRI features are most consistent with a gossypiboma that was confirmed at surgery (laparoscopic approach).

Additional contributor: Dr. H Madjour, Gynecologist, Batna, Algeria.

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