Differential Diagnosis for Right-Sided Pelvic Pain in a 53-Year-Old Woman
- Single Most Likely Diagnosis
- Ovarian Cancer: Given the patient's age, postmenopausal status, and the presence of a 7-cm right ovarian mass with solid components and thick septations on ultrasonography, ovarian cancer is the most likely diagnosis. The symptoms of bloating, decreased appetite, and pelvic pain are also consistent with this diagnosis.
- Other Likely Diagnoses
- Ovarian Cyst: Although less likely given the solid components and septations, a complex ovarian cyst could still be a consideration, especially if the patient has a history of ovarian cysts.
- Endometriosis: Although the patient is postmenopausal, endometriosis can still cause symptoms, especially if there are residual endometrial implants. However, the presence of a large ovarian mass makes this less likely.
- Diverticulitis or Other Gastrointestinal Issues: Given the location of the pain and the presence of bloating and decreased appetite, gastrointestinal causes such as diverticulitis should be considered, although the ultrasound findings would not support this as the primary diagnosis.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Although β-hCG is undetectable, which makes this diagnosis highly unlikely, it's crucial to rule out ectopic pregnancy in any woman of reproductive age presenting with pelvic pain, due to its potential for severe morbidity and mortality.
- Torsion of the Ovary: This is a surgical emergency that can present with severe pelvic pain. Although the patient's symptoms have worsened over months, acute worsening could indicate torsion, especially with a large ovarian mass.
- Appendicitis: Another surgical emergency that can present with right-sided pelvic pain. Although the ultrasound findings suggest an ovarian issue, appendicitis should be considered, especially if the patient has fever, elevated leukocyte count, or other signs of infection.
- Rare Diagnoses
- Germ Cell Tumor: These are rare ovarian tumors that can occur in postmenopausal women, although they are more common in younger women.
- Sex Cord-Stromal Tumors: Another rare group of ovarian tumors that could present with a mass and pelvic pain.
- Metastatic Disease to the Ovary: Although rare, metastases to the ovary from other primary cancers (e.g., gastrointestinal, breast) could present with similar symptoms and findings.