Presentation
Severe right-sided abdominal pain, worse with movement, nausea, no vomiting, the previous episode before, settled with antibiotics. On examination, tender RIF, no guarding/peritonism.
Patient Data
33 x 26 mm soft tissue mass in the right ovary concerning malignancy.
Further three ill-defined, enhancing, solid soft tissue lesions with surrounding inflammatory stranding in the omentum/peritoneal cavity.
Case Discussion
One of the peritoneal lesions was biopsied. The biopsy result revealed: sections from this omental biopsy show benign fibrofatty tissue containing dense acute inflammation with abscess formation centred around actinomyces-like organisms.
Pelvic actinomycosis is a rare suppurative infection. Its invasive nature leads to mass formation, which simulates pelvic malignancy. There is an association with the intrauterine device (IUD) as a method of disease introduction.
Imaging appearances are non-specific and overlap with other inflammatory and malignant conditions. Main imaging features include:
ovarian and peritoneal enhancing masses with extensive fat infiltration and abscess formation
some cases show bowel involvement in the form of mural thickening and enhancement similar to Crohn's disease
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