Reason: ovarian remnant History: pain, h/o breast cancer (estrogen receptor positive)Additional history per electronic medical record:Here for consultation for ovarian remnant syndrome. History of breast ca (triple +) s/p b/l mastectomy, and endometriosis. Prior hysterectomy for stage IV endometriosis and extensive lysis of adhesions in 2008 (Ingalls) (pathology adenomyosis, focal endometriosis). She needed a second laparotomy, lysis of adhesions, BSO in 2009 for a 10 cm left ovarian cyst and endometriosis. Noted improved pain relief with both surgeries until ~ 9 months ago. Pain has returned, left side greater than right that is similar to before surgery. Ultrasound done shows a right ~ 1 cm right ovarian remnant. Metallic susceptibility artifact from lumbosacral fusion device obscures the paraspinal and upper presacral regions.ABDOMEN:LUNG BASES: There is a nonspecific 8 mm subpleural pulmonary nodule (series 1800, image 1).LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Several small, T2 hyperintense structures within the spleen are nonspecific but most likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. No evidence of ovarian remnant in the expected location of the bilateral adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. No ovarian remnant is visualized in the expected location of the adnexa as clinically questioned, within the limitations described above.2.Nonspecific 8 mm right subpleural pulmonary nodule. Given history of breast cancer, recommend correlation with prior outside imaging to ensure stability. Otherwise, dedicated chest CT can be considered for further evaluation.