An unusual presentation of a pelvic textiloma mimicking a tumor

Abstract

A 21-year-old female patient consulted because of increasing vague pelvic pain. In her past history, an appendectomy was performed 15 years earlier. Endovaginal ultrasound showed an enlarged uterus with a nodular contour confirming the multiple leiomyomas. In the right pelvis a heterogeneous hypo vascular soft tissue mass was noted suspected to be an ovarian mass or a sub serous leiomyoma (Fig. A). At MR imaging, a right para-uterine mass was shown, sticking to the normal right ovary, excluding its ovarian origin. The mass had a hypointens signal on T1WI, heterogeneous hypo intense on T2WI and was delineated by a thick capsule showing enhancement after contrast injection (Fig. B, C). It had an extentrisic mass effect on the cervical region and pushed the right ovary in an anteroposteriorily way. A pediculated fibroma was excluded because of its characteristics. At MRI we were unable to differentiate between an old postoperative hematoma and abscess, a leiomyoma with a cystic degeneration or a pseudo cystic mass. Therefore the pelvic mass was removed by laparoscopy. The surgery revealed a nodular mass with a thick fibro sclerotic capsule and some calcifications. After opening of the nodule it was found a retained surgical sponge revealing the diagnosis of a textiloma (Fig. D).