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December 2008

10 cm. large mixed density mass in the lower abdomen
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Clinical information

Large palpable painless mass. Laboratory findings are normal.

Ultrasound Images & Clips

49 year old female, Large palpable painless mass. Laboratory findings are normal.

Transverse image of the palpable mass shows a lesion with mixed densities. There is a layering of the contents suggesting differences in specific gravity. The lesion shows no vascularity with color Doppler.
Transverse image of the palpable mass shows a lesion with mixed densities. There is a layering of the contents suggesting differences in specific gravity. The lesion shows no vascularity with color Doppler.
Transverse image of the palpable mass a little more cranial to image 1 shows a large hyperechoic area with acoustic shadowing central within the mass.
Transverse image of the palpable mass a little more cranial to image 1 shows a large hyperechoic area with acoustic shadowing central within the mass.
Transverse image of the palpable mass more cranial to image 1 and 2 shows the large hyperechoic area with acoustic shadowing filling most of the mass.
Transverse image of the palpable mass more cranial to image 1 and 2 shows the large hyperechoic area with acoustic shadowing filling most of the mass.
Transverse lateral decubitus image of the same mass shows that the fluid level now has changed to a different orientation.
Transverse lateral decubitus image of the same mass shows that the fluid level now has changed to a different orientation.
Longitudinal image with the patient in the left lateral decubitus position shows fluid with internal echoes in the mass.
Longitudinal image with the patient in the left lateral decubitus position shows fluid with internal echoes in the mass.

Conclusion

The differential diagnosis of a large cystic mass with internal echoes in the lower abdomen in a female patient include a hemorrhagic ovarian cyst, a cystic ovarian carcinoma and a dermoid cyst. The mixed very echogenic contents are very suggestive for a dermoid cyst.
A dermoid cyst or cystic teratoma can contain developmentally mature skin complete with hair follicles and sweat glands, sometimes  clumps of hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, a dermoid cyst is almost always benign.

Surgery confirmed the presence of a benign dermoid cyst.

Details

  • Sex: Female
  • Age: 49

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  • Fujifilm Ultrasound System
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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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