Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses

Artur Velcani, Patrick Conklin, Neil Specht
In: Journal of Radiology Case Reports · 2010 · vol. 4(2) , pp. 9–17 · doi:10.3941/jrcr.v4i2.133 · PMID:22470706 · PMC3303374 · W2062372775
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This case demonstrates that tubo-ovarian abscess can mimic endometrioma sonographically, highlighting the need for clinical and laboratory evaluation alongside imaging to differentiate adnexal masses.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This paper presents a case of a 36-year-old woman with worsening left lower quadrant pain where pelvic/transvaginal ultrasound showed a large complex left adnexal cystic mass with peripheral color Doppler flow, leading to diagnostic considerations including endometrioma or hemorrhagic cyst. Two days later, the patient developed fever and leukocytosis, and follow-up ultrasound showed mass enlargement, after which tubo-ovarian abscess was suspected and ultrasound-guided transvaginal drainage removed purulent fluid. The authors also include a complementary case showing similar sonographic findings in endometrioma and provide a broader discussion of imaging features of cystic adnexal masses across modalities, with the stated caveat that clinical and laboratory evaluation is important for differentiation. Relevance to endometriosis: the paper directly discusses ultrasound features that can mimic endometrioma and includes an endometrioma case as a comparator, though it is primarily a tubo-ovarian abscess case report plus a review of cystic adnexal mass imaging.

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Abstract

A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian mass on different imaging modalities.
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Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses DOI: https://doi.org/10.3941/jrcr.v4i2.133Keywords: Tubo-ovarian, abscess, sebaceous dermoid, endometriomaAbstract A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian masss on different imaging modalities. Downloads Published Issue Section License The publisher holds the copyright to the published articles and contents. However, the articles in this journal are open-access articles distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License, which permits reproduction and distribution, provided the original work is properly cited. The publisher and author have the right to use the text, images and other multimedia contents from the submitted work for further usage in affiliated programs. Commercial use and derivative works are not permitted, unless explicitly allowed by the publisher.

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