CASE 322: OVARY TWISTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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WOMAN 36 YO, 3 DAYS  AGO PAIN AT  SUPRAPUBIS, AND POLYKYURIA.

ULTRASOUND  OF  PELVIS WAS NORMAL.

PAIN CONTINUING  AND  RISING  AND SHE  WAS IN ADMISSION  OF ONE  EMERGENCY HOSPITAL,   IN CLINICAL SUSPECTED  RENAL COLICKY PAIN.

ULTRASOUND  AGAIN   DETECTED  ONE SUPRAPUBIS MASS,  SIZE OF10CM,  CYSTIC WITH  CLOUDY  FLUID INSIDE (US 1).

CDI  REPORT  WAS SMALL UTERUS, CANNOT  DETECT VASCULAR  AT  RIGHT UTERUS CORNER (US 2).

THIS CYSTIC MASS  WITH  MASS INTRA CYST  LIKED  SEBUM THAT  SUSGESTED  RIGHT OVARY TERATOMA  IN TORSION.

NO STONE  INTRA URINARY SYSTEM.

MSCT  NON CE   PRESENTED  OVARY MASS  LOOK LIKED TORSION OF TERATOMA.

EMERGENT OPERATION BY LAPAROTOMY DETECTED THIS MASS BEING AN OVARIAN CYST   BLACK IN  COLOR DUE TO TORSION ( SEE FOTO)

OPEN  SURGERY  REMOVED  RIGHT  OVARY MASS  ISCHEMIA AND BLEEDING INSIDE OF A  TERATOMA TUMOR.

Discussion : Why the first ultrasound examination was  normal?  Looking  the first picture ultrasound of the uterus that was  clear view and  the fluid  over  look liked urinary bladder.

But  you can see the small urinary bladder  in the lower corner of the first ultrasound picture.

The mistake  was due to ultrasound  scanning  with  the urinary bladder  not full filling , the ovary cyst  was not  septation because scanning view in small window.

The ultrasound examination is better  view  with  lateral decubitus position, but in some cases cannot see well in decubitus position.

Pathology report was an ovarian teratoma.