A 78-year-old man presented with fevers, cough, weakness, and diarrhea for 3 days. He had a recent hospitalization for pneumonia and acute-on-chronic renal insufficiency thought to be related to obstruction. Physical examination revealed a mildly distended abdomen with a large, nonpulsatile lower abdominal mass extending to the level of the umbilicus. Laboratory testing revealed a slight elevation in the serum creatinine level but was otherwise unremarkable. A computed tomographic scan of the abdomen and pelvis revealed a large pelvic mass with a few metallic densities about the periphery (Figure 1).
Computed tomographic scan of the pelvis shows a large, homogeneous mass with a metallic density at the periphery.
A. Iliac vein leiomyoma
B. Pelvic sarcoma
C. Internal iliac artery aneurysm
D. Distended bladder
Chance L. I, Thomas C. N. Image of the Month—Quiz Case. Arch Surg. 2010;145(9):911. doi:10.1001/archsurg.2010.168-a