Misdiagnoses of ovarian masses in children and adolescents

The purpose of this study is to describe the presenting signs and symptoms and the presumptive diagnoses of children who were admitted to our children's hospital with ovarian masses.

A retrospective chart review was performed on all patients hospitalized between November 1985 and May 1994, with a discharge diagnosis of an ovarian mass. Age, presenting symptom(s), duration of symptoms, physical exam findings, and radiologic imaging results were obtained. The preliminary and final diagnoses were recorded. For comparison purposes, the number of females with a discharge diagnosis of appendicitis for the same period was obtained.

Fifty-one patients were identified. Functional cysts accounted for 43% and tumors for 57%. During the same period, 246 females were diagnosed with appendicitis, making ovarian masses about one fifth as common. The most common presenting complaint was abdominal pain (73%). On physical examination, 69% of girls had abdominal tenderness, and 29% had a palpable mass. Thirty-eight percent of patients seen in the emergency room had a preliminary diagnosis of appendicitis. In all patients but 5, the diagnosis was confirmed by radiologic evaluation. These 5 remaining patients underwent surgery for suspected appendicitis with 3 ultimately revealing functional ovarian cysts.

Ovarian masses often present with abdominal complaints that can mimic other diseases, in particular, appendicitis. Although considered relatively uncommon, in our hospital, they comprised one fifth as many admissions as did appendicitis in females during the study period. In females that present with a clinical picture consistent with appendicitis, ovarian masses should be considered in the differential and a computed tomography scan or ultrasound should be obtained.