Mistaken identity

Not everything is as it seems in this case, where an older woman presents with a suspicious mass

Sandra is 74 years old, referred by her GP. She presents with a two-week history of abdominal distention and discomfort, anorexia and significant weight loss.

Her medical history includes chronic cardiac failure with pulmonary hypertension, atrial fibrillation (warfarinised), hypertension, chronic renal impairment, osteoporosis and limited mobility.

Examination and investigations
Her abdomen reveals massive ascites with a suprapubic mass. An urgent CT scan notes a large, complex, 11cm, left adnexal mass; large volume ascites