Differential Diagnosis
- Single most likely diagnosis
- Molar pregnancy with theca lutein cysts: This diagnosis is likely due to the presence of a heterogeneous mass in the uterus, bilateral adnexal masses (likely theca lutein cysts), and the patient's symptoms of brown vaginal discharge and pelvic pressure. The patient's history of infertility treatment and failed in vitro fertilization cycles may also increase the risk of a molar pregnancy.
- Other Likely diagnoses
- Multiple pregnancy (e.g., twins, triplets) with ovarian hyperstimulation syndrome: The patient's history of infertility treatment and the presence of bilateral adnexal masses could suggest ovarian hyperstimulation syndrome, which can occur in multiple pregnancies.
- Ectopic pregnancy with ruptured corpus luteum: Although the patient has a positive urine pregnancy test and a palpable uterus, an ectopic pregnancy cannot be ruled out entirely, especially given the adnexal masses.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ovarian torsion: The presence of bilateral adnexal masses increases the risk of ovarian torsion, which is a surgical emergency.
- Ruptured ectopic pregnancy: Although less likely given the patient's symptoms and examination findings, a ruptured ectopic pregnancy is a life-threatening condition that must be considered.
- Rare diagnoses
- Leiomyosarcoma or other uterine malignancies: Although rare, these conditions could present with a heterogeneous uterine mass and should be considered in the differential diagnosis.
- Gestational trophoblastic disease (e.g., choriocarcinoma): This rare condition could present with a uterine mass and adnexal masses, although it is less likely given the patient's symptoms and examination findings.