Case 7: Abdominal swelling
Monday, February 7th, 2011A 70-year-old female presents to ED with loin pain. This has been getting worse for several days. She describes it as a ‘nagging discomfort’. She is otherwise well.
On examining her you notice that her abdomen looks symmetrically distended. The swelling fills the lower abdomen, is non-tender, dull to percussion and extends above the umbilicus.
You wonder about chronic urinary retention and ask a nurse to pass a urinary catheter, this drains 65 mls of urine.
You arrange a CT scan (shown).
1. What is the likely diagnosis?
Click to see the answerThe CT shows a large simple cyst. The most likely cause for this is an ovarian cyst. These are relatively common, and often present late. Mesenteric cysts may also be quite large, but are much rarer.
Ovarian cysts may be benign or malignant. It would be unusual for a malignant cyst to reach this size, so a benign cause is likely.
Ovarian cysts may be simple and unilocular, as this one, or more complex with multiple cystic cavities. The more complex cysts are more likely to be malignant.