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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 40

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 40

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Five month old female with incidentally noted abdominal calcifications on a chest film.

Clinical History:
The patient was a 5 month old female who presented with increased respiratory rate and a hoarse cry and was diagnosed with croup. Abdominal calcifications were incidentally noted on a chest film obtained at that time. Upon further questioning the mother gave a history of a prenatal ultrasound which showed a simple right ovarian cyst.

Clinical Physical Exam:
No obvious mass could be palpated.

Clinical Labs:
Slightly elevated AFP and a normal beta HCG.

Clinical Differential Diagnosis:
Ovarian mass, neuroblastoma

Imaging Findings:
Abdominal film from the day of admission (not available) showed amorphous densities in the right abdomen, but no suggestion of an abdominal mass. The prenatal ultrasound was obtained the next day and reviewed and the diagnosis of prenatal simple right ovarian cyst was agreed with. An abdominal ultrasound was performed on the second day of admission (not provided) and showed a complex, solid 9 x 5 cm mass on the right side of the abdomen. It had two components, a more superior solid calcified component and an inferior cystic component. A mild amount of ascites was seen. The uterus and left ovary were well seen. The right ovary was not seen. An MRI exam done on the same day showed a heterogeneous intraperitoneal mass that was well encapsulated. The organ of origin was not determined.

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Imaging Differential Diagnosis:
Neuroblastoma, ovarian teratoma, mesenteric cyst

Operative Findings:
Ten days after the initial presentation the patient had an exploratory laparotomy through a transverse subumbilical incision. The mass was brown, smooth and soft and measured 6 x 5 x 7 cm. It was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum. It was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.

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Pathological Findings:
Examination of the surgical specimen revealed it to be an infarcted right ovary secondary to torsion in the remote past, most probably in utero, that was floating freely within the abdomen.

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Final Diagnosis:
Ovarian Torsion In Utero

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 33, Case 42


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