HISTORY:

This 48-year-old female presents with pelvic mass.

(QUIZ ANSWER) POTENTIALLY SEEN IN THIS CASE:

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

The uterus is not enlarged and measures 8.5cm in length x 5.8cm in transverse x 4.6cm in AP. The endometrium measures 1cm in thickness. Subtly indistinct appearance of the junctional zone which measures up to 13mm in size. Adenomyosis is a consideration in light of a few punctate regions of hyperintense signal on the T2-weighted series. At the posterior body of the uterus is a lesion that measures 2 x 2 x 1.5cm consistent with a uterine fibroid.

A blood-containing complex structure noted posterior to the uterus with septations and/or tortuosity but without evidence for an enhancing component. The hyperintensity on the precontrast T1-weighted sequence is consistent with the presence of blood products. The left ovary demonstrates an overall size that measures 3.6 x 3.3 x 3.2cm. Within the left ovary are two adjacent follicles with an intervening thick septation. Within the more anterior of the two follicles is a fluid-fluid level. There is no evidence for a solid mass or mural nodule of the left ovary. The pelvic tissues about the uterus and adnexa enhance more than expected.

The right ovary is difficult to visualize, but it is suspected to be posterolateral to the uterus and adjacent to the blood-containing structure at the posterior midline described above.

No pelvic adenopathy. Small quantity of free fluid in the pelvis. Small quantity of free fluid or ascites within both the abdomen and pelvis. The sigmoid colon wall adjacent to the left adnexa is thickened.

Nabothian cysts are noted within the cervix.

CONCLUSION:

1. The blood-containing structure posterior to the uterus, which represents the dominant finding and also the area of concern based upon the recent ultrasounds, is consistent with a left-sided hematosalpinx. The left ovary demonstrates two follicles and thickened intervening wall with diffuse enhancement of the left ovary. Enhancement of the soft tissues about the uterus and adnexa and the peritoneum of the abdomen. The appearance is consistent with a tubo-ovarian abscess/pelvic inflammatory disease with peritonitis.

2. Small quantity of free fluid both within the abdomen and to a lesser degree in the pelvis.

3. A uterine fibroid is identified.

4. Indistinct appearance of the junctional zone and a few punctate regions of hyperintensity on the T2-weighted sequence suggest adenomyosis.

Case Challenge

Pelvic Masses

Case 9 - 48-year-old female presents with pelvic mass