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DOI: 10.1148/radiol.2392040109
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(Radiology 2006;239:599-601.)
© RSNA, 2006

Diagnosis Please

Case 981

M. Kemal Demir, MD, Fugen Vardar Aker, MD and Neset Koksal, MD

1 From the Departments of Radiology (M.K.D.), Pathology (F.V.A.), and Surgery (N.K.), Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. Received January 25, 2004; revision requested April 2; revision received April 9; accepted May 24; final version accepted June 23. Address correspondence to M.K.D., 11 kisim, Yasemin Apt, D blok, Daire 35 Ataköy, Istanbul, Turkey 34158 (e-mail: demirkemal{at}superonline.com).


   HISTORY
TOP
 HISTORY
 
A previously healthy 69-year-old woman presented with fatigue, intermittent poorly localized abdominal pain, and discomfort of several weeks duration associated with an 8-kg weight loss. She was afebrile. Physical examination revealed abdominal distention and a palpable mass in the left lower quadrant of the abdomen. Laboratory tests did not reveal any abnormalities, with the exception of a serum CA-125 level of 560 U/mL (normal level, <35 U/mL). Gastroscopy and colonoscopy revealed normal findings. Findings of chest radiographic and recent annual mammographic examinations also were within normal limits. Computed tomography (CT) and pelvic magnetic resonance (MR) imaging were performed (Figs 1, 2). Other abdominal structures—such as the pancreas, kidneys, and bladder—appeared normal on CT and MR images (not shown).


Figure 1
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  		Figure 1a: Transverse CT images of the (a, b) lower abdomen and (c) pelvis obtained after oral administration of 5% ioxithalamate meglumin (Telebrix Gastro; Guerbet, Aulnay-sous-bois, France) and intravenous administration of 100 mL of iohexol (300 mg of iodine per milliliter) (Omnipaque; Nycomed, Oslo, Norway).

 

Figure 1
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  		Figure 1b: Transverse CT images of the (a, b) lower abdomen and (c) pelvis obtained after oral administration of 5% ioxithalamate meglumin (Telebrix Gastro; Guerbet, Aulnay-sous-bois, France) and intravenous administration of 100 mL of iohexol (300 mg of iodine per milliliter) (Omnipaque; Nycomed, Oslo, Norway).

 

Figure 1
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  		Figure 1c: Transverse CT images of the (a, b) lower abdomen and (c) pelvis obtained after oral administration of 5% ioxithalamate meglumin (Telebrix Gastro; Guerbet, Aulnay-sous-bois, France) and intravenous administration of 100 mL of iohexol (300 mg of iodine per milliliter) (Omnipaque; Nycomed, Oslo, Norway).

 

Figure 2
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  		Figure 2a: (a, b) Transverse T2-weighted fast spin-echo MR images of the pelvis (repetition time msec/echo time msec, 3500/90). (c) Transverse T1-weighted gadolinium-enhanced fast spin-echo MR image of the pelvis (550/14).

 

Figure 2
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  		Figure 2b: (a, b) Transverse T2-weighted fast spin-echo MR images of the pelvis (repetition time msec/echo time msec, 3500/90). (c) Transverse T1-weighted gadolinium-enhanced fast spin-echo MR image of the pelvis (550/14).

 

Figure 2
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  		Figure 2c: (a, b) Transverse T2-weighted fast spin-echo MR images of the pelvis (repetition time msec/echo time msec, 3500/90). (c) Transverse T1-weighted gadolinium-enhanced fast spin-echo MR image of the pelvis (550/14).

 


   FOOTNOTES
 

E-mail the most likely diagnosis to dxplease{at}rsna.org (use only for submission of diagnosis). Include case number, your name (as you would want it to appear in the journal), address, and phone and fax numbers. Only one case, one name, and one diagnosis per e-mail submission. Multiple diagnoses, multiple submissions, submissions without a case number will not be considered. Deadline: Midnight U.S. Central Time, July 15, 2006. Answer will appear in the September issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.

 





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