Presentation
Suddenly exacerbated lower right abdominal pain. History of ovulation pain. Mid-cycle at presentation. Serum inflammatory markers minimally elevated, urinary biomarkers normal.
Patient Data
Main finding at contrast CT is a right sided cystic adnexal mass 4 cm in size, with lateral hyperdensity indicative of hemorrhage or solid component. There is a thin sliver of perifocal fluid as well as moderate ascites in the pelvis. There is concentric mucosal thickening of the rectum and the left colon, consistent with concurrent viral enterocolitis. There are no signs of an acute appendicitis or diverticulitis. Status post cholecystectomy. Incidental small liver cysts.
Case Discussion
This patient presented with sudden exacerbation of abdominal pain that she had had for a few days as well as diarrhea. History of painful ovulation and menstruation, mid-cycle at presentation. Serum inflammatory markers were minimally elevated, urinary biomarkers normal. Clinically establishing an accurate diagnosis proved difficult, and the patient was referred to CT in view of the suddenly exacerbated abdominal pain.
Main finding at CT is a right sided cystic adnexal mass with lateral hyperdensity indicative of hemorrhage or solid component. There is also concentric mucosal thickening of the rectum and the left colon, consistent with concurrent viral enterocolitis.
The patient was subsequently transferred to a larger hospital, were transvaginal ultrasound confirmed the diagnosis of a hemorrhagic ovarian follicular cyst, correlating with her history of ovulation pain and mid-cycle presentation. She received antibiotic and analgesic medication and made a full recovery within a few days.
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