Tubo-ovarian abscess

Case contributed by Dr Craig Hacking

Presentation

Pelvic pain and fever. Complex past surgical history including Hirschsprung's disease.

Patient Data

Age: 27
Gender: Female
Modality: Ultrasound

The anteverted and mobile uterus is normal in size and echogenicity. There is a normal midline secretory type endometrial echo measuring 10 mm.

The right ovary measures 43 x 17 x 42mm, volume 16cc and ismobile and non tender. There are multiple small follicles within.

The left ovary measures 62 x 39 x 41mm, volume 52cc. The ovary demonstrates reduced mobility, and is tender on scanning. There was a large 4.8cm complex cystic structure, with some internal linear echoes that appears to arise from the left ovary. This hypoechoic structure is separate to the dilated, fluid filled left fallopian tube. This complex cystic structure was not present on the pelvic ultrasound from 3 years prior.

The left fallopian tube is dilated and fluid-filled, measuring up to 2 cm in maximum diameter. The tube measures a length of approximately 7 cm. At the fimbrial end of the tube, immediately adjacent to the left ovary, lies the aforementioned 4.8 cm hypoechoic structure. Mild tenderness is elicited when scanning over the tube.

Crossed fused ectopia of the left kidney again noted.

Conclusion

Left hydrosalpinx and complex hypoechoic mass almost certainly arising from the left ovary in keeping with tubo-ovarian abscess.

Modality: CT

A tubular fluid-filled structure within the left iliac fossa measures up to 2.5 cm, and is consistent with a dilated fallopian tube. A 4 x 3 cm complex cyst is seen within the adjacent left ovary. No abnormality of the uterus or right ovary.

Crossed fused ectopia of the left kidney is noted. Intestinal malrotation, with left-sided colon and right-sided small bowel. No evidence of volvulus. Duplicate inferior vena cava, with persistent left IVC draining to the left renal vein. There is also communication between left and right IVC at the level of the right common iliac artery.

Rectal faecal loading noted. A broad necked small ventral hernia (incisional) contains bowel, but without evidence of obstruction or incarceration.

No focal abnormality of the liver, spleen, pancreas, adrenals or gallbladder. The visualised lung bases are clear.

Conclusion

Dilation of the left fallopian tube is concerning for left tubo-ovarian abscess in this setting. The differential is sterile hydrosalpinx.

Incidental findings as described.

Case Discussion

Laparoscopy confirmed a tubo-ovarian abscess. The patient had a history of PID.

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Case Information

rID: 34719
Case created: 6th Mar 2015
Last edited: 22nd May 2016
System: Gynaecology
Inclusion in quiz mode: Included

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