Presentation
Two weeks history of left lower abdominal pain with tenderness, fever, and elevated inflammatory markers in a patient with a history of cesarian section two months prior.
Patient Data
Large multiloculated thick-walled collection in the left iliac fossa with a vivid enhancement of the wall and septa and restricted diffusion of the cystic-filled spaces. Surrounding inflammatory changes of the mesenteric fat with thickening and enhancement of the peritoneal reflections. Extension of the inflammatory process to the left anterior pelvic wall infiltrating the rectus abdominis and deep subcutaneous fat. Free fluid around the collection and in the pelvis.
The left ovary and fallopian tube cannot be separately distinguished within the inflammatory mass.
Normal appearance of the uterus and right ovary.
Case Discussion
The clinical presentation and the MRI features with restricted diffusion of the cystic-filled spaces are highly suggestive of tubo-ovarian abscess.
Risk factors for tubo-ovarian abscesses include:
previous pelvic inflammatory disease
multiple sexual partners
history of uterine surgery
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