Bilateral ovarian edema with unilateral ovarian leiomyoma an
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A 25-year-old regularly menstruating woman, presented with a complaint of insidious-onset right lower abdominal pain for 1 month. A significant positive history of left leg swelling since birth was present. She had a spontaneous abortion at 4 months of gestation 2 years earlier.
At the time of admission, she was afebrile with blood pressure of 110/80 mmHg, regular pulse rate of 88 beats per minute, However, there was non-pitting edema on her left leg extending up to ipsilateral labia majora. An abdominal examination revealed a 12cm×10cm firm, non-tender, mobile mass in the right side of her lower abdomen. This finding was supported by a bimanual examination. An abdominal and pelvic ultrasound examination revealed multiple fibroids in her uterus and a large hypoechoic lesion on the right adnexa.

A computed tomography (CT) scan of her abdomen showed a well-marginated thin-walled solid cystic lesion measuring 16.1cm×7.9cm×8.1cm in the abdominopelvic region. A CT scan also revealed a lobulated bulky uterus with multiple fibroids, the largest measuring 6.7cm×3.4cm in the anterior wall. Multiple homogenously enhancing mesenteric lymph nodes were noted, the largest measuring 1.3cm×1cm. A rare incidental finding of double inferior vena cava was also noted. The left inferior vena cava was noted as a continuation of left common iliac vein draining into the left renal vein, crossing anterior to the aorta, and joining the right-sided inferior vena cava. Radiological findings were suggestive of an ovarian tumor. To surprise, the left ovary was found to be enlarged measuring around 18cm×5cm with a whitish smooth surface.

The right ovary was also edematous measuring 5cm×3cm in size. Conservative surgery was performed as ovaries were edematous bilaterally and the solid lesion on the left showed no signs of invasion and metastasis. A left salpingo-oophorectomy with myomectomy was done. On the cut section, the left ovarian mass showed a solid lesion of 5cm×5cm, and the myomectomy specimen showed multiple lesions with loss of whorled appearance. Her postoperative period was uneventful and she was discharged on the fourth postoperative day with orally administered antibiotics (cefixime 200 mg twice a day for 10days), analgesics (ibuprofen 400mg+ paracetamol 500 mg three times a day for 3days then if there was a need along with pantoprazole 40mg) and multivitamins (vitamin B complex and vitamin C for a month with zinc). She was doing well and asymptomatic at 9 months of follow-up.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02418-5
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