Sonographic Features of TOA With Highly Elevated CA-125: A Case Series

Abstract

Given the significant morbidity and mortality associated with tubo-ovarian abscess (TOA), prompt diagnosis and initiation of treatment is critical. If a diagnosis is made early, medical management remains an option thereby improving the chance of conservation of reproductive organs. TOA is a sequalae of pelvic inflammatory disease (PID) and the diagnosis remains difficult due to the wide inclusion criteria for this condition, which should exclude other causes of pelvic pain. This case study presents two atypical cases of TOA in which neither patient met the diagnostic criteria for PID, on initial presentation and delayed diagnosis. Sonographic findings of enlarging, complex hyper-vascular masses and markedly elevated CA-125 levels instead raised concerns for malignancy influencing management decisions. In retrospect, utilizing these two predictive diagnostic tools may facilitate an earlier diagnosis of TOA therefore even without overt PID. This becomes more important when the clinical signs support a potential diagnosis of malignancy.