What do the masses in the pelvis represent?
Mature ovarian teratoma / dermoid cysts.
What complication has occurred? What finding in the upper abdomen is pathognomonic of this entity?
Rupture with free fat density fluid layering ante-dependently in the upper abdomen.
What evidence of a chemical peritonitis is present?
Smooth thickened and enhancing peritoneum.
The term dermoid and mature teratoma are often used interchangeably when referring to these ovarian lesions. Is this correct?
Ovarian dermoid cyst and mature cystic teratoma are terms often used interchangeably, and although they have very similar imaging appearances the two have a fundamental histological difference: dermoids are composed only of dermal and epidermal elements, whereas teratomas have mesodermal and endodermal elements.
Two masses composed of fat and fluid with a calcific focus (likely tooth) are seen with in the pelvis There is surrounding fat stranding. A chain of fat density material is seen extending from the right mass along the right iliac vessels. Liquid fat density material is also seen throughout the abdomen forming fat fluid levels best seen anterior to the left lobe of the live liver and anterior to the spleen.
Fluid filled abdominal cavity with enhancing peritoneum (right side greater than left). No definite free air identified. Large bowel is fluid filled. The liver, spleen, adrenal glands, kidneys and pancreas are unremarkable. Lung bases and bones are unremarkable.