A Huge Ovarian Cyst: Why is it Missed?

A 15-year-old girl presented with progressive abdominal distention for four months duration. An initial assessment by primary care and gynaecological teams concluded that the ascites as the cause based on the clinical and initial ultra sonographic findings. However, an abdominal radiography revealed that a huge mature cystic teratoma as the actual cause of the presenting issue. Despite being a rare incidence, this case report highlighted why a high index of suspicion of ovarian pathology in large abdominal fluid accumulation in the paediatric population should be raised. The case report also highlighted the value of abdominal radiography, particularly in a primary care setting facility in differentiating intra-abdominal mass and ascites, especially when the massive volume of ovarian mass hampered the ultrasound findings. Though it is not specific, it may improve accuracy of initial diagnosis leading to an appropriate investigation with timely referral to the appropriate department. The unusual component of this case was the ‘pseudoascites' presentation and the literature on the detail of distinction between the two conditions from the primary aspect point.