Haemorrhagic ovarian cyst

A haemorrhagic ovarian cyst usually results from haemorrhage into a corpus luteum or other functional cyst. 

Radiographic features

Ultrasound

They can have a variety of appearances depending on the stage of evolution of the clot. The most typical appearances are that of lace-like reticular echoes or an intracystic solid clot.  

There should not be any internal blood flow, however circumferential blood flow in the cyst wall is typical. Clot may adhere to cyst wall mimicking a nodule, but has no blood flow on Doppler imaging. 

Pelvic MRI

Relatively well defined cystic lesion in association with the ovary. Signal characteristics can vary depending on the age of the haemorrhage. In an acute setting

• T1 - high signal
• T1 C+ (Gd) - no enhancement
• T2 - low signal

Management and prognosis

Most haemorrhagic cysts resolve completely within two menstrual cycles.

Cysts with a typical appearance of a haemorrhagic cyst should lead to follow-up ultrasound or MRI imaging if :

• the cyst is > 5 cm in diameter if the patient is pre-menopausal or
• any size of haemorrhagic cyst if the patient is post-menopausal ² 

In the late menopausal patient, surgical evaluation is warranted.

Differential diagnosis

Differential considerations on ultrasound include

• cystic ovarian neoplasm : the most helpful feature in distinguishing hemorrhagic cysts from ovarian neoplasms is the presence of papillary projections and nodular septa in the latter.
• endometrioma : typically contains uniform low level internal echoes

See also

• haemorrhagic corpus luteal cyst