A 30-year-old female presents with severe cyclic pelvic pain, dysmenorrhea, deep dyspareunia, and painful defecation (dyschezia) for 2 years. Physical examination reveals nodularity and tenderness along the uterosacral ligaments. Transvaginal ultrasound demonstrates an ovarian cyst with homogenous low-level ground-glass internal echoes ('chocolate cyst'). What is the diagnosis?
Answer and explanation
Correct answer: A. Endometriosis with endometrioma
- Step 1: Endometriosis is the presence of functioning endometrial glands and stroma outside the uterine cavity.
- Step 2: The presence of dysmenorrhea, dyspareunia, and dyschezia with an ovarian endometrioma exhibiting characteristic ground-glass echoes on ultrasound confirms the diagnosis.
Answer
Endometriosis with endometrioma.
Why not the others: 'Polycystic ovary syndrome (PCOS)' presents with oligomenorrhea, hirsutism, and peripheral follicles in a 'string of pearls' configuration; 'Pelvic inflammatory disease (PID)' presents with acute pelvic pain, purulent cervical discharge, cervical motion tenderness, and fever; 'Ovarian dermoid cyst (teratoma)' demonstrates hyperechoic calcified components and acoustic shadowing.
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