Pyomyoma

Abstract

A 30-year-old woman was admitted with a 6-week history of fever and suprapubic pain radiating to the back. She had undergone an uncomplicated elective caesarean section 12 weeks earlier because of a 57 mm cervical fibroid.

On examination, a tender fixed 20-week size mass was felt arising from the pelvis. Laboratory investigation found a C-reactive protein (CRP) of 252 mg/l (range 0 – 5.0) and a white blood cell count of 15.8×109/l. Cultures of blood, vaginal and cervical swabs, and a mid-stream urine sample were all negative. Tumour markers were within normal limits. An abdominal X-ray excluded any retained swabs.

Transabdominal and transvaginal ultrasound showed a 13 cm diameter fixed, non-fluctuant mass with low level echo, posterior to the uterus. The mass had an 8 mm thick capsule. Neither ovary could be visualised