Massive Ovarian Oedema in Pregnancy: A Diagnostic Dilemma

Massive oedema of the ovary is a rare clinical entity and poses a clinical challenge due to the potential for misdiagnosis. This is a case of a 27-year-old pregnant woman with incidentally detected ovarian oedema on routine dating scan. She was asymptomatic. Clinical examination revealed a midline pelvic mass, which was firm to hard in consistency, corresponding to a 14-week size of a gravid uterus. After medical termination as requested by the patient, further imaging was done. Contrast-enhanced CT showed a well-defined cystic lesion in the left adnexa with a thick, irregular enhancing wall and multiple intensely enhancing tortuous tufts of vessels seen from the ovarian artery and draining into the left ovarian vein, likely of old ovarian ectopic pregnancy. Hence, a beta-human chorionic gonadotropin test was done to rule out ectopic pregnancy. The patient underwent exploratory laparotomy as a conclusive diagnosis could not be reached. Histological examination finally revealed ovarian oedema.