期刊名称：Journal of Education and Teaching in Emergency Medicine
印刷版ISSN：2474-1949
出版年度：2019
卷号：4
期号：1
页码：1-4
DOI：10.21980/J8934X
出版社：University of California Press
摘要：History of present illness: A 19-year-old female with no pertinent past medical history presented to the
emergency department with sharp, non-radiating, intermittent right lower quadrant abdominal pain that
began two months ago. Pain was worse with movement. She denied nausea, vomiting, constipation, fevers,
chills, vaginal bleeding or discharge, and dysuria. A distended abdomen was noted on physical exam. She was
sent to the emergency department by her primary medical doctor after a mass was found on ultrasound and
computed tomography (CT). She noted a history of irregular menses and denied a history of sexually
transmitted infections. She denied a family history of ovarian, endometrial, colon or breast cancer.
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Significant findings: The CT scan with oral contrast in the emergency department revealed a large
heterogeneous abdominopelvic mass measuring 13.2 x 18.8 x 23.1 cm (see white lines), suggestive of an
ovarian teratoma from the right ovary. This mass included fat, fluid, calcifications (see yellow arrows), and
enhancing soft tissue components. The teratoma resulted in mass effect upon large and small bowel loops
(see blue highlighted areas), inferior vena cava (IVC), distal aorta (see red highlighted area) and right common
iliac artery. A small volume of ascites was also observed. There was no evidence of bowel obstruction,
vascular occlusion or other significant emergent finding. Additionally, transabdominal and transvaginal
ultrasound images were obtained. The transabdominal image visualized the abdominopelvic mass (see four
yellow stars). The transvaginal image visualized a cross section of the teratoma (see four red stars) in relation
to the bladder (see four blue stars).
Discussion: Ovarian teratomas are the most common nonepithelial benign ovarian tumor with about 30% of
diagnosed women presenting with abdominal or pelvic pain.1 Associated symptoms due to mass effect
include abdominal pain, constipation and urinary retention.2 The use of transvaginal ultrasonography in the
emergency department is an excellent tool to identify benign teratomas, with a reported sensitivity of up to
86% and specificity of 99%.1
The highest incidence of ovarian teratomas occur in women of reproductive age (20-40 years) though they
can occur at any age.3 The most common complication associated with ovarian teratomas is ovarian torsion,
reported in 3% to16% of cases.4 Torsions are more common with intermediate size tumors compared to small
or very rare large ones.5 A 34-year study analyzing mature cystic teratomas revealed that the mean size for
a teratoma with torsion was 6.5±2.6cm and the mean size for a teratoma that led to rupture was 5.3±3.9cm.6
Rarely, ovarian teratomas may present with intestinal obstruction which occurs when a small intestine loop
adheres to the tumor. Secondary symptoms include constipation or diarrhea, rectal bleeding or urinary
frequency.7
Patient was informed to schedule outpatient follow up for preoperative planning with gynecology because
she would need surgical management given the size of her teratoma.
