Presentation
Right iliac fossa pain with vomiting.
Patient Data
The right ovary is not visualised. Heterogenous solid-cystic mass seen in the right iliac fossa with extension beneath segment VI of the liver. The cystic component contains debris and calcifications within. No colour doppler seen within the mass, thus suggestive of ovarian torsion.
The right fallopian tube is oedematous with minimal vascularity within. A normal fallopian tube is not usually seen on ultrasound.
Free fluid within the pelvis.
The uterus is normal.
Left adnexa is not seen in this ultrasound.
The normal right ovary is not visualised. The uterus is anteverted.
Well-defined mass arising from right adnexa with enhancing component, fat, and calcified component noted within. No clear plane with the adjacent bowel wall. Engorged vascular pedicle noted. Adjacent free fluid extending to pelvis.
Normal left ovary.
A well-defined hypodense intraperitoneal lesion with a calcified wall posterior to segment VI liver edge.
Fatty liver. No focal liver lesion. No biliary duct dilatation. Portal vein is patent.
Gallbladder, pancreas, spleen, both adrenals and kidneys are normal.
No bowel related mass, abnormal bowel dilatation or bowel wall thickening.
Urinary bladder is normal.
No significant abdominal and pelvic nodes.
Peritoneal fluid cytology shows no malignancy was detected.
Histopathology of the right ovary and right fallopian tube shows partly infarcted benign mature cystic teratoma and paratubal cyst.
Histopathology of omentum shows no malignancy seen.
Case Discussion
CA-125 level was slightly raised at 94.5 U/ml (normal range less than 35). The CA 19-9 was markedly raised at 482 U/ml (normal range less than 37).
The radiological diagnosis was a right adnexal lesion suspicious of immature cystic teratoma complicated with torsion, suspicious intraperitoneal lesions, possible peritoneal metastasis, and fatty liver.
Exploratory laparotomy, unilateral salpingectomy, and omentectomy were done. Intra-operative findings showed haemorrhagic ascitic fluid encountered upon entering the peritoneum. Gangrenous right ovarian tumour twisted x3 measuring 10 x 10cm. The capsule is intact. The uterus is normal. The left fallopian tube and left ovary are normal. The peritoneum, subdiaphragmatic space, liver, spleen, omentum, and bowel are normal.
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