EURORAD ESR

Case 15153

Pelvic actinomycosis

Author(s)
Mariana Lima, Ana Luísa Lourenço, Isabel Oliveira, Ana Cardoso

Department of Radiology, Centro Hospitalar de Lisboa Central - Hospital de Santo António dos Capuchos; Alameda de Santo António dos Capuchos, 1169-050 Lisbon, Portugal; Email: mariana_talina@hotmail.com
 
Patient
female, 50 year(s)
 
 
  • Figure 1
    Pre- and post-contrast axial CT: left pelvic mass
     

    Pre-contrast axial CT showing a left pelvic mass (circle).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Post-contrast axial CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Post-contrast coronal CT: left pelvic mass
     

    Post-contrast coronal CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Post-contrast coronal CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    Post-contrast axial CT: left pelvic mass and sigmoid parietal thickening

    Post-contrast axial CT showing a left heterogeneous pelvic mass (circle) that is locally invasive and extends to the sigmoid colon, which shows parietal thickening and enhancement (arrow).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    Axial CT: Intra-uterine device (IUD)

    Axial CT showing an intra-uterine device (IUD) inside the endometrial cavity.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 5
    Post-contrast axial CT: left uretero-hydronephrosis
     

    Post-contrast axial CT showing left mild hydronephrosis.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Post-contrast axial CT showing dilation of the left ureter.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 6
    Post-contrast coronal CT: left uretero-hydronephrosis
     

    Post-contrast coronal CT that demonstrates left hydronephrosis, with the left ureter dilated upstream to the left pelvic mass and showing a “stop” in that region (ellipse).

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Post-contrast coronal CT that demonstrates left hydronephrosis. Note the asymmetry of renal excretion.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 7
    MR axial T1-weighted images: left pelvic mass
     

    MR axial T1 weighted-image without fat saturation showing a left pelvic mass (circle).

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    MR axial T1 weighted-image with fat saturation showing a left pelvic mass (circle).

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 8
    MR axial T2-weighted images: locally infiltrative left pelvic mass
     

    MR axial T2-weighted image showing a left pelvic mass (circle), which is heterogeneous, with hyperintense areas (cystic/necrotic). There is stranding of the surrounding fat (white arrowhead).

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    MR axial T2-weighted image showing a left heterogeneous pelvic mass (circle), with hyperintense areas (cystic/necrotic). There is stranding of the surrounding fat (white arrowhead) that extends to the pre-sacral fat...

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    MR axial T2-weighted image showing a left heterogeneous pelvic mass, with hyperintense areas (circle). There is parietal thickening of the sigmoid colon (arrows) and stranding of the pre-sacral fat (arrowhead).

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 9
    MR sagittal T2-weighted images: locally infiltrative left pelvic mass

    MR sagittal T2-weighted image showing an heterogeneous left pelvic mass, with central areas of T2-hyperintensity (circle) and stranding of the surrounding fat that extends to the pre-sacral fat (arrowhead).

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 10
    MR T1 post-gadolinium images: locally infiltrative left pelvic mass
     

    MR axial T1-weighted image post-gadolinium showing a pelvic heterogeneous mass, with central cystic/necrotic areas (circle). There is stranding of the surrounding fat (arrowhead) and parietal thickening and...

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    MR axial T1-weighted image post-gadolinium showing a heterogeneous mass (circle). There is stranding of the surrounding fat that extends to the pre-sacral fat (arrowhead) and parietal thickening and hyperenhancement...

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 11
    MR T1 post-gadolinium images: locally infiltrative pelvic mass

    MR coronal T1-weighted image post-gadolinium showing a pelvic heterogeneous mass, with central cystic/necrotic areas (circle). It is associated with stranding of the surrounding fat.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 12
    MR T1 post-gadolinium images: locally infiltrative left pelvic mass

    MR sagittal T1-weighted image post-gadolinium showing a pelvic heterogeneous mass (circle), with central cystic/necrotic areas. There is important stranding of the surrounding fat that extends to the pre-sacral fat...

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 13
    Axial CT: post-operative residual aspects
     

    CT scan (10 months after surgery) showing a densification area in the region where there was the pelvic mass, which probably corresponds to post-surgical fibrosis. We can also see the presence of bilateral ureteral...

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT scan (10 months after surgery) showing the presence of bilateral ureteral stents.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
Pre-contrast axial CT showing a left pelvic mass (circle).
 
Post-contrast axial CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).
 
Post-contrast coronal CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).
 
Post-contrast coronal CT showing a left pelvic mass, which is heterogeneous, with central cystic/necrotic areas (circle).
 
Post-contrast axial CT showing a left heterogeneous pelvic mass (circle) that is locally invasive and extends to the sigmoid colon, which shows parietal thickening and enhancement (arrow).
 
Axial CT showing an intra-uterine device (IUD) inside the endometrial cavity.
 
Post-contrast axial CT showing left mild hydronephrosis.
 
Post-contrast axial CT showing dilation of the left ureter.
 
Post-contrast coronal CT that demonstrates left hydronephrosis, with the left ureter dilated upstream to the left pelvic mass and showing a “stop” in that region (ellipse).
 
Post-contrast coronal CT that demonstrates left hydronephrosis. Note the asymmetry of renal excretion.
 
MR axial T1 weighted-image without fat saturation showing a left pelvic mass (circle).
 
MR axial T1 weighted-image with fat saturation showing a left pelvic mass (circle).
 
MR axial T2-weighted image showing a left pelvic mass (circle), which is heterogeneous, with hyperintense areas (cystic/necrotic). There is stranding of the surrounding fat (white arrowhead).
 
MR axial T2-weighted image showing a left heterogeneous pelvic mass (circle), with hyperintense areas (cystic/necrotic). There is stranding of the surrounding fat (white arrowhead) that extends to the pre-sacral fat (blue arrowhead).
 
MR axial T2-weighted image showing a left heterogeneous pelvic mass, with hyperintense areas (circle). There is parietal thickening of the sigmoid colon (arrows) and stranding of the pre-sacral fat (arrowhead).
 
MR sagittal T2-weighted image showing an heterogeneous left pelvic mass, with central areas of T2-hyperintensity (circle) and stranding of the surrounding fat that extends to the pre-sacral fat (arrowhead).
 
MR axial T1-weighted image post-gadolinium showing a pelvic heterogeneous mass, with central cystic/necrotic areas (circle). There is stranding of the surrounding fat (arrowhead) and parietal thickening and hyperenhancement of the sigmoid colon (arrow).
 
MR axial T1-weighted image post-gadolinium showing a heterogeneous mass (circle). There is stranding of the surrounding fat that extends to the pre-sacral fat (arrowhead) and parietal thickening and hyperenhancement of the sigmoid colon (arrows).
 
MR coronal T1-weighted image post-gadolinium showing a pelvic heterogeneous mass, with central cystic/necrotic areas (circle). It is associated with stranding of the surrounding fat.
 
MR sagittal T1-weighted image post-gadolinium showing a pelvic heterogeneous mass (circle), with central cystic/necrotic areas. There is important stranding of the surrounding fat that extends to the pre-sacral fat (arrowhead).
 
CT scan (10 months after surgery) showing a densification area in the region where there was the pelvic mass, which probably corresponds to post-surgical fibrosis. We can also see the presence of bilateral ureteral stents.
 
CT scan (10 months after surgery) showing the presence of bilateral ureteral stents.
 
 
 
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