Presentation
Two-day history of right upper quadrant pain radiating to the right lower quadrant and around to her back. Associated symptoms of nausea with multiple bilious vomits.
Patient Data
There is a large lobulated heterogeneous cystic lesion arising from the right hemipelvis. The lesion contains fatty and soft tissue densities as well as foci of calcification which are suspicious for mature cystic teratoma arising from the right ovary.
Note there is also a whirlpool appearance at the pedicle of the ovarian mass which may indicate torsion.
There is also a large lobulated heterogeneous cystic lesion arising from the left hemipelvis. The lesion contains fatty and soft tissue densities as well as foci of calcifications. Again, this is suspicious for a mature cystic teratoma.
Incidental finding of cholelithiasis.
The patient proceeded to have a mini-laparotomy with bilateral ovarian cystectomy and right ovarian reconstruction.
The intra-operative findings confirmed:
ischemic right ovary with 3 separate, large dermoid cysts
bruising along the infundibulopelvic ligament at the point of torsion
the left ovary had 5 separate dermoid cysts containing hair, sebum and skin tissue
Case Discussion
Mature cystic ovarian teratoma or ovarian dermoid cyst (terms are used interchangeably) are benign ovarian tumors 1. They characteristically have tissue formed from ectodermal, mesodermal and endodermal germ cell layers which include skin, hair, teeth, fat, muscle and sebaceous material 2.
The whirlpool sign as seen on this patient's CT demonstrates the twisting or torsion of the ovarian pedicle. Correlation with ultrasound assessing for absence of color doppler flow which supports a diagnosis of torsion 3.
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