Pelvic hematoma following angiography: another cause of elevated serum CA-125

The presence of a pelvic mass in a patient with an elevated serum CA-125 suggests the possibility of a gynecologic malignancy. However, an increasing number of nonneoplastic causes of elevated serum CA-125 have been reported. This is the first report of a pelvic hematoma associated with elevated serum CA-125. Two weeks following cardiac catheterization at time of myocardial infarction a patient was noted to have a complex pelvic mass on ultrasound and serum CA-125 of 53 units per milliliter. Abdominal-pelvic CT-scan showed a small left pleural effusion, minimal ascites, left lower quadrant abdominal wall masses consistent with omental metastases, and a 9.4 x 10.3 x 9.0-cm complex left adnexal mass. At exploratory laparotomy a large organized hematoma in the left paravesical space was adherent to both the left external iliac artery and the left bladder wall. This mass could have been managed expectantly with percutaneous aspiration if a nonmalignant diagnosis had been more strongly considered.