Twisted Fate: Third Trimester Ovarian Dermoid Cyst Torsion

Background: This case illustrates the challenges of clinical assessment of a pregnant patient in the third trimester. Use of non-radiation-based imaging modalities become more critical in the evaluation of the surgical abdomen in pregnant mothers. We discuss the advantages of ultrasound (US) and Magnetic Resonance Imaging (MRI) in the evaluation of a pregnant lady. Case Report: A 29-year-old lady, gravid 2 para 1 at 32 weeks gestational age presented with intermittent right iliac fossa pain. Physical examination revealed poorly localising right sided abdominal tenderness. An US performed showed a large mass in the right iliac fossa but was otherwise non-diagnostic. Subsequently torsion of an ovarian dermoid cyst was diagnosed with unenhanced MRI. Urgent surgery was performed thereafter with good outcome. Conclusion: Unenhanced MRI is now widely available and is increasingly a helpful tool for diagnosis to achieve prompt treatment and symptom relief.