Suspicion of Ovarian Neoplasm in the Setting of New-Onset Ascites and Elevated CA-125: The Role of Transvaginal Ultrasound in A Secondary-Level Hospital. A Case Report

Introduction: New-onset ascites in women without known systemic disease represents a relevant clinical warning sign that requires exclusion of intra-abdominal malignancy, particularly of gynecologic origin. In secondary-level hospitals, diagnostic limitations may delay evaluation, making structured clinical reasoning essential.for timely decision-making. Case report: A 33-year-old woman presented with progressive abdominal distension and dyspnea. Significant ascites was documented, with no history of hepatic, cardiac, or infectious disease. Transvaginal ultrasound revealed an irregular left adnexal mass measuring 5.0 × 7.0 cm associated with free fluid. Markedly elevated CA-125 levels (600 U/mL) were documented. Based on the integration of clinical findings, ultrasound features, and tumor markers, the patient was classified as high risk for ovarian malignancy (O-RADS US 5; IOTA malignant criterion M2), and was urgently referred to a tertiary-level gynecologic oncology center for definitive management. Conclusions: The integration of clinical assessment with transvaginal ultrasound and serum biomarkers allows early suspicion of ovarian neoplasm and appropriate referral, even in a secondary-level hospital with limited diagnostic resources.