[Intraabdominal dermoid cyst in the differential diagnosis of ascites]

A 60- year-old Hungarian woman known to be alcohol-dependent, consulted her family physician because of generalized weakness and an enlarged abdomen Her doctor started diuretic treatment assuming that liver cirrhosis with ascites was the cause. After three months she was referred to our hospital because of dyspnea and orthopnea as well as edema in the legs.

On admission to the Department of Medicine, Elizabeth Hospital in Sopron (Hungary) the patient was in a critical condition with severe cachexia, muscular atrophy and no palpable adipose tissue. Her abdomen was severely distended by a large amount of abdominal fluid. Abdominal paracentesis was performed, which revealed feculent and fatty shining fluid.

Laboratory tests showed low levels of total protein, albumin, cholesterol and iron. Microcytic anemia, leucocytosis and a high erythrocyte sedimentation rate were also found. Transaminases, urea, creatinine, lipase, amylase and electrolytes were within normal range. Protein and lipid levels of the abdominal fluid were high.

Abdominal ultrasound and computed tomography (CT) were performed after hemodynamic stability and normal blood pressure had been achieved. Abdominal ultrasound showed that the abdominal cavity was full of fluid, which contained numerous round shiny objects with a capsule-like covering. Abdominal CT confirmed that the abdomen contained a partly cystic mass within which there were round objects, about 3 cm in diameter. These findings established the diagnosis of dermoid cyst. The patient died five hours after admission. At autopsy there was evidence of organ compression, severe malabsorption and malnutrition, pulmonary congestion, and myocardial atrophy.

In a patient with ascites, liver cirrhosis or intraabdominal having been ruled out, an intraabdominal dermoid cyst should be considered in the differential diagnosis. The outcome in this patient was largely determined by her failure to consult a doctor early, having failed to appreciate the seriousness of her condition.