CASE 450: PID with PELVIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  34 yo with  onset 2 weeks ago,  fever  and pain at pelvic region.

Ultrasound  first at an obgyn hospital  says  ovary cyst or endometriosis. But medical  management  with antibiotis failed in clearing fever.

(US 1: scanning  after 2wks,  uterus and cystic mass # 10cm with very thickening wall; US 2 : on CDI;  US 3:  intracystic mass detecting one structure like a bridge: US 4:  ascites intra RLAQ;  US 5:  this mass was scanned with linear 12 MHz probe. 

MRI of pelvis with gado=   this cystic mass is  in left ovary  with  the wall very thick, and  black spot intra mass  unknown  original,   but radiologist  suspected an ovary cancer.

   

Blood tests=   WBC  12k with 70% neutron,  Plt= 515,  CA 125  rising  100 UI.

 18 DAY FEVER AGO CANNOT STOP BY ANTIBIOTICS.  OPERATION BY LAPAROENDOSCOPY WITH DIAGNOSIS  OF P I D.
Picture OPE1: LEFT OVARY IS VERY BIG MASS AND FALLOPEAN TUBE IS BIG ALSO.  

Picture OPE 2: INCISION OF THE WALL OF CYSTIC MASS SHOWING VERY THICK AND an AMOUNT of PUS  GOES OUT.

Picture OP 3: VASCULAR THROMBOSIS INTRACYSTIC MASS.

BACTERIOLOGY  REPORT  of THE PUS from STREPTOCOCCUS  and  MICROSCOPIC REPORT of THE WALL of CYST IS  ABSCESS WALL.

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