34-year-old woman with history of ovarian cyst surgery

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

Case Section

Genital Female Imaging

Patient's Information

Gender : Female
Age : 34

Clinical Summary

34-year-old woman presented with unchanged cystic lesion despite of 2 times history of surgery

Imaging Findings

The images demonstrate a well-defined multiloculated thin-walled cystic lesion in the retrorectal space involving the left ischiorectal fossa with fluid content.The rectum and uterus are displaced anteriorly and left ovary is engulfed in the anterior extension of the lesion.The dominant cyst contains small peripheral cysts which some of them show hyperdense attenuation on CT scan image along high signal intensity on T1-weighted images suggestive of proteinaceous or hemorrhagic fluid.Metalic sutures (red arrow) related to the previous surgery is also noted.

Differential Diagnosis

1.Developmental cysts in the retro-rectal region(retrorectal epidermoid cyst,retrotectal dermoid cyst,retrorectal neurenteric cysts),2.Cystic sacrococcygeal teratoma ,3.Anterior sacral meningocele,4.Anal duct cyst,Anal gland cyst,5.Necrotic rectal leiomyosarcoma,6.Extraperitoneal adenomucinosis,7.Cystic lymphangioma in retrorectal region,8.Retrorectal pyogenic abscess,9.Necrotic sacral chordoma

Final Diagnosis

Tailgut duplication cyst

Discussion (Related Text)

Tailgut cysts (also known as retrorectal cystic hamartomas) are rare congenital multicystic lesions that arise from vestiges of the embryonic hindgut and are most common in middle-aged women (mean age, 35 years). Most occur in the retrorectal space, although they can occur less frequently anterior to the rectum or in the subcutaneous tissue of the sacrococcygeal or anorectal locations.They are usually asymptomatic but may be associated with abdominal pain or perirectal symptoms because of mass effects. Tailgut cysts are multiloculated cystic lesions with thin walls and a glistening lining and are filled with mucin and debris.

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.