Managing Lesion of Adnexa

Q: I am a 34 year old female. I went to the ER with severe abdominal pain localized above my naval. Blood work showed increased white blood cell count. CT scan, pelvic and abdominal ultrasounds showed a rt adnexal lesion and free fluid in the pelvis. I will have a follow up with my gynecologist and family physician. I also have shortness of breath and difficulty with bowel movements for 2-3 weeks. What can cause this, and treatment?


Right adenexa means, all the structure present on the right side of the uterus. This would include the right ovary, the right fallopian tube and the ligaments and muscles supporting the uterus.

Adenexal Lesion

A rt. adenexal lesion may be a mass/ lesion arising from the ovary, the tube or the uterus itself !

It cannot be said with certainty what it is.

You need thorough follow ups. Your doctor will first investigate to find out from what tissue this lesion is arising. A tissue sample (biopsy) may be required.

Possible Causes

Ovarian Cyst

If it is from the ovary, it may be an ovarian cyst. These are common in your age group. This may be benign or cancerous.

Since you have mentioned some free fluid in your pelvis, the possibility of malignancy needs to be ruled out. Although, you are young for any cancers.

It may be some lesion arising from the tube.


The tube on the right side may be swollen due to some infection. Such a condition is called hydrosalpinx (water in tube).

Many PIDs (pelvic inflammatory diseases) present in this way. The inflamed tube may have given you the pain. Did you have any fever along with it?

Such condition are treated with antibiotics. Sometimes, surgical drainage of the tube is required.

Endometriosis in the Tube

Here the uterine tissue grows outside the uterus to give a mass like lesion. Since this tissue secretes during monthly cycles, fluid is collected. The patient usually complains of irregularity of menses and pain during bleeding.

Tumor in the Tube

This is extremely rare.

Tubo-ovarian Abscess

The lesion could be a tubo-ovarian abscess. This is collection of pus in the rt. adenexa. The condition is secondary to some pelvic infection.

Exophytic Fibroid

This is a growth from the muscular wall of the uterus. The condition is painful. Menstrual disturbances often accompany.

Any mass in the right adenexal region can press over the nearby bowels to disturb bowel movements.

Your need to get diagnosed first. Depending upon what the adenexal mass is, treatment would be given.

You may read about a similar problem here.

Take Care,

Buddy M.D.

Medical Advice (Q&As) on “Adenaxal Mass With Free Fluid in Pelvis

  1. Uma

    I have been treated for breast cancer and am now cancer free for two years.
    I have had an ovarian cyst in the left ovary for the past three years.
    I have had a recent scan which shows a) A Cyst with low level echoes of size 5.2 by 4 by 4.5 cm is seen in the left adnexa.
    b) Both ovaries are not seen separately.
    c) No evidence of free fluid noted in the Peritoneal / pleural spaces.
    d) No Para-aortic lymphadenopathy.
    Complex cyst with low level echoes in left adnexa probably ovarian origin.
    What do you advice?

    1. Buddy M.D. Post author

      You need to go for further investigation. Get your blood tumor markers checked. It is important to know the nature of the adnexal mass.

  2. M.I.Zaman

    Dear Sir/ Ma’am

    Kindly tell me is medicine enough or surgery is a must if a female ( aage-30 years ) patient has ” Cystic SOL in Pelvic region”.

    I will wait for kind opinion.
    Thanks and regards.

    1. Buddy M.D. Post author

      The modality of treatment would depend upon the nature, that is, the type of pelvic SOL. Whether the SOL is malignant or not, whether it responds to hormones or not, is there some pelvic infection accompanying the lesion and so on.

      SOLs that have an infective origin are treated by giving appropriate antibiotics. Those that respond to hormones are given hormones as the first line of treatment.

      Lesions that are cancerous, too big in size, have a risk of rupture, or not responding to hormones, may be resected out surgically.

  3. Racquel

    The right ovary contains cyst with low-level internal echoes suggestive of haemorrhage, possible leaking. There is free fluid in the adjacent right adnexa. What would you suggest is the best treatment?

    1. Buddy M.D. Post author

      If internal bleeding is significant, urgent surgical is required to drain it out and replenish by blood loss by IV administration.

      Small leakages may be self limiting. A close observation is all you need.

  4. Lucy

    Went for ultra sound find out a small amount
    Of fuild in the porch of Douglas!
    I am 66 years old female, is it uncommon for my age?