article · Annals of African Medicine
Pelvic masses in females present diagnostic challenges because of the anatomical complexity of the pelvic region. A case study describes a 26-year-old woman presenting with a five-year history of gradual lower abdominal swelling, dull radiating cramps, urinary retention, dysuria, and urinary frequency. Initial ultrasound imaging indicated an ovarian mass, a uterine fibroid, and a suspected bladder mass. Exploratory laparotomy revealed a left ovarian mass alongside a large calcified pelvic mass extending from the uterine isthmus across the posterior bladder wall and anterior vaginal wall. Following a left ovariectomy and surgical removal of the mass, histological analysis confirmed a mature ovarian teratoma and a cervical fibroid. The patient recovered smoothly with antibiotics and analgesics. The findings illustrate the diagnostic limitations of ultrasound scans in low-resource settings and demonstrate that laparotomy can serve as a diagnostic tool when advanced imaging such as magnetic resonance imaging is unavailable or unaffordable.
Accurately diagnosing female pelvic masses remains difficult in low-resource healthcare environments that rely heavily on ultrasound scans. When complex masses mimic bladder tumours or other urinary pathology, relying purely on first-line ultrasound can lead to misinterpretation. Recognising these diagnostic challenges underscores the selective value of surgical intervention and highlights the need for affordable, accessible advanced imaging modalities such as magnetic resonance imaging.
The abstract describes a clinical case and notes the potential value of accessible, affordable magnetic resonance imaging for complex pelvic diagnosis. However, it does not present a specific technology, product, or development pathway. For technology developers and healthcare organisations, it highlights an unmet clinical need for low-cost, high-resolution diagnostic imaging tools tailored for low-resource environments, though the case report itself remains purely clinical without an active commercialisation pathway.
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Female pelvic masses could be difficult to diagnose given the fact that there are so many structures within the pelvis that could be related to the mass. These benign or malignant neoplasms could be diagnosed through careful and systematic evaluation by history, biochemical, imaging, and surgical approaches. Although an ultrasound scan is often the first-line imaging modality for the evaluation of pelvic masses, it could be limited by poor acoustic windows and poor depth penetration. However, in low-resource settings, its usage is nonnegotiable. The case of a 26-year-old female with a 5-year history of lower abdominal swelling is hereby presented. The swelling was gradual in onset and associated with occasional dull lower abdominal cramps that radiate to the back, urinary retention, dysuria, and urinary frequency. An ultrasound scan diagnosed an ovarian mass and uterine fibroid with the suspicion of a bladder mass. She had a laparotomy, in which a left ovarian mass and a huge calcified pelvic mass extending from the region of the isthmus of the uterus through the posterior bladder wall and the anterior vaginal wall were discovered. Left ovariectomy and removal of the mass were done; a histologic diagnosis of mature ovarian teratoma and cervical fibroid was made. She had a smooth postoperative recovery on antibiotics and analgesics. The diagnostic challenge of pelvic masses even with the use of USS is demonstrated, and laparotomy has shown to be a diagnostic procedure here. Preoperative magnetic resonance imaging could be helpful when available and affordable.
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DOI: 10.4103/aam.aam_180_24
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