Diagnosis and resection of a giant ovarian cyst presenting in a young patient with contralateral back pain and lower limb deep vein thrombosis

BMJ Case Rep. 2021 Mar 16;14(3):e239673. doi: 10.1136/bcr-2020-239673.

Abstract

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.

Keywords: radiology (diagnostics); reproductive medicine; venous thromboembolism.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Back Pain / etiology*
  • Diagnosis, Differential
  • Diagnostic Imaging / methods*
  • Enoxaparin / therapeutic use
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Leg
  • Magnetic Resonance Imaging
  • Ovarian Cysts / complications*
  • Ovarian Cysts / diagnostic imaging*
  • Ovarian Cysts / surgery
  • Ovary / diagnostic imaging
  • Ovary / surgery
  • Tomography, X-Ray Computed
  • Ultrasonography, Doppler
  • Venous Thrombosis / diagnostic imaging*
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / etiology*
  • Young Adult

Substances

  • Enoxaparin
  • Fibrinolytic Agents