Retroperitoneal hematoma masquerading as ovarian malignancy

Abstract

Background: Retroperitoneal hematoma presents with a diagnostic difficulty, especially when it does not present with acute symptoms. Lack of history of any previous intervention, such as femoral catheterization, can add to the diagnostic dilemma. Case: A 71-year-old woman was referred to the Gynaecology Oncology division of the Department of Obstetrics and Gynaecology at the National University Hospital, Singapore for suspected ovarian malignancy. Imaging studies showed a complex adnexal mass infiltrating into the recti muscles. A core biopsy from the mass was inconclusive. Results: Diagnostic laparoscopy confirmed a retroperitoneal hematoma, and the patient was managed conservatively. Conclusions: Retroperitoneal hematoma should be kept as a differential diagnosis of ill-defined pelvic masses with unclear imaging studies, especially in the setting of normal tumor markers and history of anticoagulation therapy. The role of fine needle aspiration cytology (FNAC) and diagnostic laparoscopy should be considered, as it may prevent operative morbidity substantially. © Copyright 2012, Mary Ann Liebert, Inc. 2012.