A 16-year-old female presents with irritative voiding symptoms progressing to “urinary retention.” Evaluation with a computed tomography scan is shown in Exhibits 1 and 2.
Evaluation with a renal, bladder, pelvic sonogram shows two normal kidneys.
1. C. Ovarian cyst
2. A. Laparoscopic removal
The differential diagnosis of a large, fluid-filled pelvic mass in a female should always include Mullerian structures. In this case, the large mass is a simple ovarian cyst (causing all of the irritative symptoms), and the urinary catheter is in the decompressed bladder off to the patient’s left. The patient has two normal kidneys (which would be a key fact to sort out early and not shown in the imaging), which rules out a duplicated hemivagina with one side obstructed and an ipsilateral pelvic renal nubbin (OHVIRA syndrome) as well as a duplicated system with an upper pole obstructed ureter from ureteral ectopy and/or a ureterocele. In addition, obstructed vaginas tend to have old blood and not simple fluid as shown in this case. In males, an enlarged prostatic utricle and seminal vesicle cyst should be considered in the differential diagnosis.
The urinary catheter irrigated without issues and could be seen on real-time sonogram as separate from the large ovarian cyst. The cyst was drained and removed laparoscopically (Exhibits 4 and 5), along with the effaced right ovary with resolution of her symptoms.
Ovarian pathology for the pediatric urologist. Urology 2011; 77:1455-9.
Evaluation, Treatment and Follow-up Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients. J Pediatr Adolesc Gynecol 2017; 30:449-55).
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