Giant ovarian cyst presenting with reversible cardiac compromise: a case report.

Introduction and importance: Giant ovarian cysts are rare in contemporary practice due to early radiological detection. Cardiac compromise resulting from mechanical compression by such masses is exceptionally uncommon and poses significant diagnostic and perioperative challenges, particularly in resource-limited settings. Case presentation: A 39-year-old woman presented with a 4-month history of progressive abdominal distension, fatigue, and dyspnea. Imaging revealed a massive multiloculated cystic ovarian mass measuring 38 × 31 × 24 cm, compressing surrounding viscera. Transthoracic echocardiography demonstrated global left ventricular hypokinesia with a reduced ejection fraction of 30-35%, consistent with cardiac dysfunction secondary to mass effect. The patient underwent fertility-preserving staging laparotomy, including right salphingo-oophorectomy. The excised mass measured 40 × 40 cm and weighed 18.6 kg. Histopathology confirmed a borderline mucinous cystadenoma confined to the right ovary (FIGO stage IA). Clinical discussion: Giant ovarian cysts can rarely induce reversible cardiac dysfunction through elevated intra-abdominal pressure and impaired venous return. Early echocardiographic assessment and multidisciplinary coordination are essential for risk stratification and perioperative planning. In this case, cardiac function improved following tumor removal, supporting a compression-related mechanism rather than intrinsic cardiomyopathy. Conclusion: This case highlights a rare but life-threatening presentation of reversible cardiac compromise caused by a giant ovarian cyst. Timely diagnosis, echocardiographic evaluation, and coordinated surgical management enabled a favorable outcome despite limited resources, emphasizing the importance of early intervention in similar high-risk presentations.