Case (56)

[Naira]

38yrs old female present wth swelling of her lower abdomen she has being married for 12yrs bt unfortunately did not conceived for the last 6months her menstural period became very heavy n last more days then usually

On examination:
pt looks pale
pulse was 80/min
tempreture 37c
blood presure 120/80
abdominal examination irregular firm pelvic abdominal mass wich was not tender

Questions:    
(1)what is the most likely diagnosis ?
(2) what  other possible couses?
(3) what are the investigations u like to do ?
(4) how to confirm diagnosis

[Kassim]

(1)   what is the most likely diagnosis ?
Uterine Fibromyoma
2) what  other possible causes?
Pregnency,
Polycystic overian  syndrome
Ovarian cancer
Uterine leiomyoma
3) what are the investigations u like to do ?
First role out Pregnancy, UPT
Pelvic  U/S, to find out what is in there, solid mass, o r cyst.
Also to find out the cause of the infertility:
Laboratory:  Female: FSH, LH ratio, to R/O polycystic ovarian Syndrome (PCO),
                      Thyroid profile to R/O Hyperthyrodism
                     FBP
                     Male: Semen analysis 
Radiology: Female: HSG to see if the fallopian tubes are patent or not, if patent then Laparoscopic examination of the uterus.
Pelvic  U/S, to find out what is in there, solid mass, o r cyst.
If UPT is negative, then the most likely Diagnosis is Uterine Fibroid, U/S will confirm.
How do we manage this patient: if infertility is due to PCO, then Metformin 500mg TDS + Folic Acid 5mg OD +weight loss.  If no success then  ovulation induction.
If its huge uterine Fibroid, then myomectomy  or TAH.
HOPE THIS THE RIGHT ANSWER