Presentation
Severe right groin pain for six days. Not able to bear weight on right limb. Shock. Past history of metastatic ovarian cancer and hysterectomy.
Patient Data
Peritoneum/mesentery: Minimal complex ascites in and around the pelvis, consistent with established metastatic ascites. Moderate omental thickening, predominantly in the left upper quadrant, suggesting potential for metastatic spread. There is a little loculated ascites measuring 2.5 x 6 x 3cm in the right side of the pelvis with a water density of [5 HU]. There was no intraperitoneal abscess. There were no peritoneal masses.
Iliacus/groin/thigh: The right iliacus muscle is nearly three times wider than the left side. It is approximately 3cm wide, compared to approximately 1cm on the left side. It contains ill-defined fluid densities and air. Edema is present in the muscles and fat planes of the right groin and thigh, with extensive air bubbles extending to the bottom part of the leg. The extensor and adductor muscle groups are the most affected. Except for the iliacus muscle, no fluid pooling is observed in the affected area. There is no discernible abscess in the thigh.
Abdominal wall: Fluid-filled small left para-umbilical hernia.
Case Discussion
This is an instance of ovarian cancer that has spread to the peritoneum with mild complex ascites and omental thickening. A suspected small abscess in the right iliacus muscle has findings of a deep soft tissue infection that is necrotizing and that extends down the right leg. Although there is no localized abscess within the thigh, the appearance of numerous air bubbles in edematous muscles of a septic patient is consistent with necrotizing fasciitis in the right thigh.
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