Ovarian mucinous cystadenoma mimicking the urinary bladder

Case contributed by Dr Sammy Droubi

Presentation

Patient presented with abdominal pain and distension. She reported recent history of urinary frequency and incontinence.

Patient Data

Age: 30 years
Gender: Female

At initial glance on axial view, a fluid-containing pelvic structure resembles the bladder with some focal wall thickening. On further review, particularly on coronal and sagittal planes, this is determined to be a left ovarian cystic lesion causing mass effect as well as compression of the bladder. 

A cystic lesion is again seen compressing the urinary bladder. Ultrasound demonstrates increased complexity of the lesion with thick septations and mural nodules, suspicious for neoplasm. 

Pathology confirmed a benign mucinous cystadenoma (12 cm) replacing most of the left ovary. 

Case contributed by: Sammy Droubi MD, David Miller, Travis Sapp MD, Matthew Aagesen MD, and Michael Enzerra MD.

Case Discussion

This patient presented with abdominal pain and distention as well as increased urinary frequency and incontinence. A CT abdomen and pelvis revealed what at first appeared to be a distended bladder with irregular focal wall thickening. However, closer inspection revealed a large left ovarian lesion causing mass effect with compression of the urinary bladder, presumably contributing to her urinary symptoms. Sagittal view was used to better delineate the pelvic structures as well as tracing the course of the left ovarian vein from the lesion to the IVC. Subsequent ultrasound was performed complementing these findings while revealing more concerning features including thick septations and mural nodularity, concerning for neoplasm. The lesion was then excised and pathology confirmed an ovarian mucinous cystadenoma. Following excision, the patient experienced resolution of her symptoms.

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