Emergency ultrasound case of the month….2014 !! Rest of the case and diagnosis

10 Jan

The ultrasound showed a right kidney with a little bit of hydronefrosis, mild at most, but the “money shot” was in the pelvis ..
A large cystic mass with anechoic to hyperechogenic content, some concrement-like structures were also seen within.

Right kidney                                       Left kidney

Casus EM dutch jan 2014 re nierCasus EM dutchjan 2014 li nier

Pelvic view

Casus EMdutch jan 2014 + uitleg
The patient was sent to gynaecology where a transvaginal ultrasound was done …. with similar findings.

On basis of the findings of  the ultrasound(s) she was brought to the OR. Where the gynaecologist found the large cyst (9 – 6 – 5 cm) which had facilitated a torsion of the right ovary. Luckily the ovary could be spared.

The pathology report showed : Cyst with skin, bone, cartilage and braintissue..  conclusion : mature teratoma

Final diagnosis : Large mature teratoma with torsion of the right ovary (and little bit of  hydronefrosis of  the right kidney)

A few pearls can be taken from this case in my humble opion:

-Be sceptic of other people’s diagnosis when a patient is handed over to your care, don’t let it narrow your frame of thinking

-Emergency ultrasound can guide your management in the right direction within seconds.Without it you might lose valuable time (and in this case an ovary)

-Always scan the pelvis/bladder after doing  renal ultrasound, don’t be satisfied with hydronefrosis, check if you can identify the cause downstream. (also always take a look at the aorta by the way, AAA /iliacal aneurysm can also be a cause of hydronefrosis and mimic renal colic)

– Torsion of the ovary can be a tricky diagnosis, pelvic exam not always helpful.

Love to hear your comments on this case …. Check EMdutch in a month or so for the next emergency ultrasound case !!