Imaging in a Patient with Recent Cesarean Section and Acute Right Lower Quadrant Pain Due to Torsion OF Ovarian Teratoma – Diagnostic Challenges

Abstract

Abstract Introduction: Ovarian teratomas are common pathology, manifested by various clinical and imaging findings, as well as different complications. The differential diagnosis can be challenging in cases with acute right lower quadrant (ARLQ) pain. Aim: to present typical imaging findings in this pathology and possible pitfalls in their interpretation, focusing on a case with torsion of ovarian teratoma. Methods: We describe a case of a 41-yearold female patient with a recent Cesarean section and a history of kidney stones and previous appendectomy, who presented with acute right lower quadrant pain. Her pregnancy was uneventful. The plain abdominal X-ray, ultrasound and computer tomography images revealed air-fluid levels, a fecaloma in the ascending colon and a pelvic mass of unclear origin, misinterpreted as a foreign body or postoperative complication. Results: The patient underwent a surgical procedure that revealed an ovarian teratoma torsion. A right adnexectomy was performed. The diagnosis was confirmed by histological examination. Conclusion: An excellent knowledge of the imaging findings in the diseases presented with ARLQ pain is of vital importance, however patient’s co-morbidities and recent surgical procedures may hinder the correct interpretation.