Bilateral tubo-ovarian abscesses
A 55-year-old patient with a history of recurrent pelvic pain and fever.
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- Multi-septated thick walled mass is on the left side of the pelvis continuous with a dilated tortuous left fallopian tube, displacing the uterus medially. This contains focal cystic filled spaces, which exhibit diffusion restriction. The wall and septae of the mass avidly enhance. Perilesional fat stranding and minimal free fluid. The ovary is not separately identified. It is measuring about 7.2X6.7X7.7 cm along its maximum anteroposterior, side to side and cranio-caudal dimensions respectively. A similar yet smaller tubo-ovarian lesion is seen at the right side as well measuring 5.5X4X4.6 cm along its maximum anteroposterior, side to side and cranio-caudal dimensions respectively.
- Enlarged uterus showing a myometrial well defined lobulated mass lesion at its left posteroinferior wall at the lower uterine segment, measuring about 3.8X4.3X4 cm along its maximum anteroposterior, side to side and cranio-caudal dimensions respectively. It appears of intermediate T1 and T2 signal with whorly appearance. Such large myometrial lesion is deforming the lower endometrial cavity and cervical canal. Another similar smaller fundal mass is seen as well measuring 1.6 cm.The endometrial thickness is measuring 4 mm.
- Few cervical Nabothian cysts.
Bilateral pelvic masses more sizable on the left side consistent with bilateral tubo-ovarian abscesses.
The appearance of the adnexal multi-septated lesion with convolutions showing enhancing walls and septae as well as diffusion restriction are diagnostic of a tubo-ovarian abscess. The diagnosis was confirmed by clinical and laboratory correlation confirming its inflammatory nature.