Gynaecology for students and practitioners . Fig. 407. Labge Cystic Kidney simu-lating AN Ovarian Cyst. Patient erect. 716 GYNiECOLOGY discharges. Apart from this, the specific serum-reaction is the onlypossible means of pre-operative diagnosis (see p. 329). (3) Very large abdominal cysts must be distinguished from extremedegrees of ascites, whether simple or associated with intra-abdominalmalignant disease, and from fibro-cystic tumours of the uterus. Withthe patient lying on her back, in ascites the clearest note on percussionis obtained around the umbilicus, the dullest note in the flanks ;
Gynaecology for students and practitioners . Fig. 407. Labge Cystic Kidney simu-lating AN Ovarian Cyst. Patient erect. 716 GYNiECOLOGY discharges. Apart from this, the specific serum-reaction is the onlypossible means of pre-operative diagnosis (see p. 329). (3) Very large abdominal cysts must be distinguished from extremedegrees of ascites, whether simple or associated with intra-abdominalmalignant disease, and from fibro-cystic tumours of the uterus. Withthe patient lying on her back, in ascites the clearest note on percussionis obtained around the umbilicus, the dullest note in the flanks ; inovarian cysts the converse is the case. In cases of ascites the distribu-tion of dulness shifts readily with changes of posture, but with ovarian. Fig. 408. Large Fibro-cystic Tumour of the Uterus. recumbent. Patient cysts dulness does not shift except to a very slight extent. In ascitessome causal condition, such as cirrhosis of the liver, may be detected,or the presence of hard nodular masses in the abdomen may suggestadvanced malignant disease with secondary deposits. It is very uncommon for fibro-cystic tumours of the uterus to attainthe enormous size of the largest ovarian cysts, and if it has been deter-mined that the fluid is encysted and not free, the probability that it isovarian is very high. Nevertheless numerous instances have beenrecorded in which a tumour of this character revealed itself as a fibro-cystic uterine tumour on opening the abdomen {see Fig. 408). Thedifferential diagnosis is not of great practical importance, as thetreatment in either case is to remove the tumour. Occasionally arenal cystic tumour may attain the size of the largest ovarian cyst,even to the extent of producing pendulous belly {see Fig.
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
