Postmenopausal Tubo-Ovarian Abscess with Air in the Ovarian Vein

Tubo-ovarian abscess (TOA) is usually recognized as a complication of pelvic inflammatory disease and highly associated with sexual activities in reproductive age group. However, even rare, TOA can be presented in a woman with genitourinary malignancy, diabetes mellitus, and usage of intrauterine device (IUD) in postmenopausal age group. Air in ovarian vein is a rare CT finding of TOA. We present the case of an 81-year-old woman with TOA from actinomycosis and E. coli, which was not associated with history of malignancy, diabetes mellitus and usage of IUD. The uncommon CT findings such as air-fluid level, intramural air, and air in the ovarian vein are also presented. J Radiol Sci 2012; 37: 35-38 Correspondence Author to: Ruey-An Chiang Department of General Surgery, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan No. 1, Lane 303, Chang-Sha Street, Taitung 950, Taiwan Postmenopausal TOA with air in the ovarian vein 36 J Radiol Sci March 2012 Vol.37 No.1 air, and intravascular air in the left ovarian vein. Intraperitoneal free air was also identified, suggesting rupture of the lesion into the peritoneal cavity with peritonitis (Fig. 1). The patient underwent left salpingo-oophorectomy and a perforated, gangrenous ovarian mass was found without evidence of adnexal torsion. Severe adhesion between the mass and the sigmoid colon was also noted; perforation of the sigmoid colon was identified and then being repaired during surgery. The histopathologic examination disclosed actinomyces-like organism in the lesion (Fig. 2). The ascites culture yielded E. coli. After surgery, the patient was discharged in stable condition.