Case 2

This is a contrast enhanced CT study of the abdomen and pelvis, showing a large, thick walled, multi-loculated fluid collection in the pelvis, extending into the abdomen – this appears to be in the left adnexa. The left fallopian tube is fluid filled – indicating pyosalpinx- and distended with thick walls. On the post contrast images, the walls of the collection and the distended fallopian tube are enhancing. The right adnexa is also thickened and enhancing, but is not distended with fluid / pus. There are multiple smaller fluid collections around the adnexae, representing abscesses. There is surrounding inflammatory fat stranding and pelvic free fluid extending up the paracolic gutters and into the perihepatic space.

There are no solid soft tissue masses in the adnexae. Therefore, this is primarily an infectious inflammatory process manifesting with pyosalpinx and tubo-ovarian abscesses in a patient with pelvic inflammatory disease.

Incidentally, there are a few simple bilateral renal cysts.

I note that a Foley catheter has been placed in the urinary bladder, with the balloon in adequate position.

There is also a liver lesion in segment IVB which demonstrates peripheral arterial enhancement and filling in on the portal venous phase, representing a haemangioma.

I would contact the referring physician and convey the findings for urgent management; referral to the emergency OBGYN service is warranted.