Presentation
The patient presented to Emergency Department with right lower quadrant tenderness and heavy sporadic vaginal bleeding with clots for a month. Amplified probe test for Neisseria gonorrhoeae came back positive.
Patient Data
Large complex right adnexal mass is most concerning for tubo-ovarian abscess. Heterogeneous lesion in the left ovary is also suspected to represent sequela of pelvic inflammatory disease such as a smaller tubo-ovarian abscess or pyosalpinx. Mullerian duct duplication anomaly most suggestive of a bicornuate uterus.
Case Discussion
Radiologic findings of the large complex right adnexal mass demonstrating thick wall and internal heterogeneous material along with a positive test for gonorrhoea are most concerning for a tubo-ovarian abscess, sequela of pelvic inflammatory disease. Similarly, the left adnexal complex lesion, while indeterminate, might also represent a smaller tubo-ovarian complex or pyosalpinx.
Mullerian duct anomaly of the uterus, most suggestive of a bicornuate uterus. Differential includes didelphys and septate. Consider MRI for future evaluation.
The case was reviewed and discussed with Dr. Morlie L. Wang MD, MPH, Program Director of Diagnostic Radiology who stood in agreement with the findings.
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