3 months of constipation

55yo female presented with 3/12 of abdominal bloating, discomfort and constipation. Normally opens bowels daily, but lately has been going up to 3 times a day, small volumes, pasty texture, never fully formed.

At the same time, she had constant crampy pelvic pain which she has attributed to wind. Urination has also been affected with Sx of frequency, but nil dysuria or fevers. 

She had a PHx of breast Ca in remission. Only on tamoxifen.

While waiting for doctor review, the nurses noted high PVRs on bladder scan. Urine dipstick was NAD. 

On Ex

Her abdomen was mildly distended but soft, nil tenderness, nil guarding. Obs stable.

The ED doc had a look with the US:

R Adnexa

What does the pelvic US show?

R adnexa (annotated)

The ED doc then looked at the RUQ:

RUQ 

What does the RUQ US show?

RUQ (annotated)

CT abdomen confirmed these findings: bilateral cystic adnexal masses, peritoneal mets and ascites with a DDx of metastatic breast or ovarian Ca.