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BACKGROUND
A 32-year-old woman presents to her gynecologist complaining of dull pelvic pain worsening over the last several months. She is currently sexually active with one partner and denies having any previous sexually transmitted diseases. Sexual intercourse is, at times, uncomfortable but rarely painful. She has had irregular menses but states that her menses have always been somewhat irregular and that it “runs in the family.” She denies having a fever, weight loss, vaginal discharge, dysuria, diarrhea, or constipation.
On physical examination, the patient has normal vital signs and is a moderately overweight woman who appears well and is in no apparent distress. Abdominal examination reveals no fullness or tenderness to palpation. However, pelvic examination reveals a large, palpable mass in the left adnexa with mild tenderness to palpation. The patient has no vaginal discharge and no cervical motion tenderness.
The urine pregnancy test result is negative. Findings on wet-mount examination and urinalysis are normal. Cultures for Neisseria gonorrhoeae and Chlamydia organisms are ordered, and the patient is referred for pelvic ultrasonography. Sonograms revealed an 11-cm left adnexal mass with a complex appearance and cystic component (not shown). The patient had localized pelvic ascites. Contrast-enhanced multisection CT was then performed for further evaluation (see Image). What is the likely diagnosis? |
Hint
The condition is a common, benign ovarian mass. |
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Authors:
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Heather DeVore, MD, UCLA - Olive View Medical Center Residency, Department of Emergency Medicine, Olive View - UCLA Medical Center
Ali Nawaz Khan, FRCS, FRCP, FRCR, Consultant Radiologist, Department of Diagnostic Radiology, North Manchester General Hospital, UK
Klaus L. Irion, MD, PhD, Consultant Radiologist, Department of Radiology, The Pennine Acute Trust, UK |
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eMedicine Editors:
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Ada Jain Kumar, MD, Department of Radiology, Evanston Northwestern Healthcare
Rick Kulkarni, MD, Attending Physician, Director of Informatics, Department of Emergency Medicine, Olive View - UCLA Medical Center, Assistant Professor of Medicine, David Geffen School of Medicine at UCLA
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