Ms Victoria Wright, Dr Rajni Chauhan, Mr Erick Leyva Caraballo

 

Objective 

An interesting cases demonstrating diagnostic and management challenges of adnexal masses presenting in pregnancy. Initially presenting as a complex right ovarian cyst causing compression of the right ureter but at caesarean section was discovered to be a paravaginal cyst with retroperitoneal extension.

Case Report 

A 24-year-old G2P1 presented at 28 weeks of gestation with acute abdominal pain.

 

Discussion

This case highlights the challenges of diagnosis in pregnancy and the importance of MDT working and consideration of alternative diagnosis. It shows the limitations of imaging even with the current advancements and importance of clinical examination.

Masses are being diagnosed more often in pregnant patients with increased monitoring and the improvements in ultrasound. Cases are most likely to be benign in nature but inclusion of MDT discussion with gynaecological oncology teams is essential. This patient was managed conservatively and although loss of her kidney function due to obstructive hydronephrosis is significant if she had been operated on during pregnancy her mass would have been difficult to access, and she could have suffered significant morbidity from that.

 

Conclusion

This case demonstrated the challenges in the diagnosis and management of adnexal masses in pregnancy. It shows the importance of MDT working and for obstetricians and gynaecologists to work closely together. It highlights the limitations of investigation and the importance of interpretation of the whole clinical picture.