An interesting case highlighting the difficulty in differential diagnosis between a tubo-ovarian abscess, cystic ovarian tumor, and ectopic pregnancy. Whilst likely showing a right tubo-ovarian abscess, in the clinical context a cystic ovarian tumor is considered less likely and an ectopic pregnancy cannot be excluded. Correlation of imaging findings with the beta HCG was recommended in discussions with the treating clinician.
A CT abdo/pelvis with contrast 6 days later showed insinuation of the complex mass into anatomical spaces more in keeping with a tubo-ovarian abscess, did not show any fetal parts to support an ectopic pregnancy but could not entirely exclude a cystic ovarian neoplasm.
A repeat US 1 month later found the cystic mass within the right adnexa to have increased in size with ultrasound appearance in keeping with hydrosalpinx or tubo ovarian abscess.