Differential Diagnosis for Pelvic Mass with Possible Gynecologic Origin and Leukocytosis
Single Most Likely Diagnosis
- Ovarian Torsion: This condition is a gynecologic emergency that can present with a pelvic mass and leukocytosis due to possible infection or necrosis of the ovary. The torsion cuts off the blood supply, leading to severe pain and potentially systemic signs like fever and elevated white blood cell count.
Other Likely Diagnoses
- Pelvic Inflammatory Disease (PID): PID can cause a pelvic mass due to tubo-ovarian abscesses and is often associated with leukocytosis due to the infectious nature of the disease.
- Ovarian Cyst or Tumor: Large ovarian cysts or tumors can present as a pelvic mass. If infected or if there's a rupture, they can also cause leukocytosis.
- Endometriosis: Although less commonly associated with leukocytosis, large endometriomas can present as a pelvic mass, and if there's superimposed infection, it could lead to an elevated white blood cell count.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although typically presents early in pregnancy, a ruptured ectopic pregnancy can cause a pelvic mass and significant leukocytosis due to internal bleeding and potential infection. Missing this diagnosis can be fatal.
- Appendicitis: If the appendix is located in the pelvic region (retrocecal appendix), appendicitis can mimic a gynecologic condition, presenting with a pelvic mass and leukocytosis. It's crucial not to miss this diagnosis due to the risk of perforation and peritonitis.
- Diverticulitis: Similar to appendicitis, diverticulitis, especially if involving the sigmoid colon, can present with a pelvic mass and signs of infection, including leukocytosis.
Rare Diagnoses
- Germ Cell Tumors: Certain germ cell tumors of the ovary can grow rapidly and present with a large pelvic mass. If there's necrosis or infection, they can also cause leukocytosis.
- Lymphoma: Although rare, lymphoma can involve the pelvic lymph nodes and present as a pelvic mass. Systemic symptoms, including leukocytosis, can occur, especially if there's significant disease burden.
- Sarcomas: Uterine or ovarian sarcomas are rare but can present with a rapidly growing pelvic mass. Leukocytosis might be seen in the context of tumor necrosis or infection.