A 26-year-old female, gravida one was referred to the radiology department with a history of lower abdominal pain, nausea and vomiting for the last 2 days, gradual in onset and progression. The patient had no significant medical or surgical history. She neither received any medication for 6 months before pregnancy nor underwent any assisted reproduction therapy. Menarche occurred at the age of 15 years, and her menstrual periods were regular. Her family history was negative for tuberculosis or gynecological malignancy. The vital signs were as follows: blood pressure of 100/60 mmHg, pulse rate100 bpm, body temperature 36.2 C, and respiration rate 26/min with normal preliminary blood counts.
Ultrasonographic examination revealed a live intrauterine gestational sac at 6 weeks gestation, with bilaterally enlarged, multicystic ovaries measuring 15x12 cm on the right side and 14x11 cm on the left side with ascites (Figure 1). The rest of the abdomen was unremarkable. Chest US examination revealed bilateral mild pleural effusion with no pericardial effusion.
A provisional diagnosis of severe OHSS in spontaneous pregnancy was made. Differential diagnosis of tuberculosis and malignancy was also considered. Further imaging with MRI confirmed OHSS (Figure 2). The beta hCG level corresponded to the weeks of gestation. Estradiol level was elevated and amounted to 3000 pg/mL (reference value for the 1st trimester is 188-2479 pg/mL); CA 125 was normal. The patient was managed with intravenous fluid and 5% albumin, and subjected to regular physical, biochemical, and radiological monitoring. The patient was discharged and advised to undergo weekly follow-ups. The pregnancy progressed to term without any other complications. A follow-up MRI after 6 weeks post-partum revealed a simple ovarian cyst in the left ovary with complete regression of s-OHSS (Figure 3).