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  • Diagnosis and resection of a giant ovarian cyst presenting in a young patient with contralateral back pain and lower limb deep vein thrombosis

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Case report
Diagnosis and resection of a giant ovarian cyst presenting in a young patient with contralateral back pain and lower limb deep vein thrombosis
  1. Duranka Perera1,
  2. Anita K Bolina2,
  3. Nazneen Hoque1 and
  4. Khalil Razvi3
  1. 1Southend University Hospital NHS Foundation Trust, Southend On Sea, Essex, UK
  2. 2Imperial College London Faculty of Medicine, London, UK
  3. 3Obstetrics and Gynaecology, Southend University Hospital NHS Foundation trust, Westcliff On Sea, UK
  1. Correspondence to Duranka Perera; duranka.perera{at}nhs.net

Abstract

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.

  • venous thromboembolism
  • radiology (diagnostics)
  • reproductive medicine

https://doi.org/10.1136/bcr-2020-239673

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    Footnotes

    • Contributors Having been the first to see the patient in question, DP both conceived of and wrote the first draft of the case report as well as collecting the figures, consenting the patient and interviewing the patient post-op for the perspective section. AKB contributed grammatical and content-based revisions of the initial draft, suggesting and generating tables to present differentials and blood test values. NH suggested inclusion of specific imaging to act as further proof of the linked pathology, assisting in its acquisition and sharpening the textual content in further drafts. KR operated on the patient and offered specific insights into alternate thrombotic presentations to be included within the general discussion. All authors offer final approval of this version of the document for publication and agree to be held accountable for all aspects of the work, including its accuracy and integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.