Student Uses VisualDx and CT Scan to Guide Woman’s Abdominal Pain Diagnosis Leading to Surgery

Cory A, an OMS-III studying gynecology at Burrell College of Osteopathic Medicine, details how VisualDx helped a medical student assess a woman in the ER with lower abdominal pain and guide the diagnosis and removal of a teratoma.

“A 31-year-old G2P2 female presented to the emergency room with mild RLQ and right lateral abdominal pain with no palpable masses, rebound tenderness or organomegaly. There is no relevant past medical history or contributory family history. Transvaginal and transabdominal ultrasound revealed a cystic mass 9.3 x 6.3 x 8.8 cm in the left adnexal region, a normal left ovary, and no identifiable right ovary. IUD was located in a normal-appearing uterus displaced slightly to the right. Doppler flow was normal. CT scan noted a 8.6 cm mixed-density mass containing fat, soft tissue and calcifications occupying the left adnexal region and vesicouterine pouch. Diagnosis of a right ovarian benign cystic teratoma was made based on the identified mix of tissues in the cystic mass. Ca-125 levels were not assessed due to the tumor’s benign characteristic appearance on imaging. Laparoscopic ovarian cystectomy was performed on the right ovary with sparing of ovarian parenchyma and cystic capsule rupture upon dissection. A retrieval bag was used to remove the cystic contents from the pelvic cavity. The right ovary was torsed upon entry into the pelvis but regained its color upon reversal of the torsion. Pathology report revealed a thin-walled cyst filled with a large mass of hair, bone-like elements and yellow sebaceous material. The largest soft tissue fragment (Rokitansky protuberance) measured 6.5 x 3.8 x 3.2 cm and contained a polypoid fragment of pink-tan epithelium with underlying yellow adipose and portions of partially calcified hemorrhagic soft tissue suggestive of bone formation with cartilage. A total of 9 teeth were identified with one canine, multiple molars and others with non-distinct appearance. Cartilage, boney matrix complete with red marrow cells, muscle, sebaceous glandular tissue and both keratinized and non-keratinized epithelium were seen microscopically in the specimen. No ovarian or fallopian parenchyma was identified. VisualDx was used initially by our medical student working up the patient’s lower abdominal pain post-CT scan which was highly suspicious for a benign ovarian cystic teratoma. Imaging on VisualDx did not have the calcifications indicative of teeth that were present in our patient, but were still helpful in diagnosis.”

*1st picture is of the teratoma removed from patient.

*2nd picture is the CT scan the medical student referred to when using VisualDx.