Corpus luteal cyst rupture
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- updated 22 Aug 2022:
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Ruptured corpus luteal cysts are one of the commonest causes of spontaneous haemoperitoneum in a woman of reproductive age.
Clinical presentation
Presentation is variable, ranging from completely asymptomatic to severe abdominal pain due to peritoneal irritation.
Pathology
The corpus luteum is a thick-walled cystic structure that is prone to internal haemorrhage, and sometimes peritoneal rupture.
Radiographic features
Ultrasound
- complex adnexal cyst
- rim of increased echogenicity surrounding a cystic component
- free fluid with areas of increased echogenicity representing
hemoperitoneumhaemoperitoneum - on Doppler, peripheral vascularity may be seen ("ring of fire sign")
- at times the entire rupture and haemorrhage form an organised haematoma and a complex vascular adnexal mass
CT
- well circumscribed cystic lesion
- thick walled cyst (<3 mm) with inhomogeneous contrast enhancement
- high attenuation component (45-100 HU)
- “fluid-fluid
hematocrithaematocrit” level -
hemoperitoneumhaemoperitoneum with free fluid near the source of bleeding can have high attenuation value (60-65 HU), “sentinel clot” and the attenuation of free fluid reduces further from the source
Differential diagnosis
Possible considerations include:
- ruptured ectopic pregnancy: evaluation of serum βhCG-levels is necessary to differentiate ruptured corpus luteal cyst from ruptured ectopic pregnancy, which may have a similar presentation
- ruptured ovarian cyst: no haemoperitoneum
-<p><strong>Ruptured corpus luteal cysts</strong> are one of the commonest causes of spontaneous <a href="/articles/haemoperitoneum">haemoperitoneum</a> in a woman of reproductive age.</p><h4>Clinical presentation</h4><p>Presentation is variable, ranging from completely asymptomatic to severe abdominal pain due to peritoneal irritation.</p><p><strong>Pathology</strong></p><p>The <a href="/articles/corpus-luteum">corpus luteum</a> is a thick-walled cystic structure that is prone to internal haemorrhage, and sometimes peritoneal rupture.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><ul>-<li>complex adnexal cyst</li>-<li>rim of increased echogenicity surrounding a cystic component</li>-<li>free fluid with areas of increased echogenicity representing hemoperitoneum</li>-<li>on Doppler, peripheral vascularity may be seen ("<a href="/articles/ring-of-fire-sign-adnexa">ring of fire sign</a>") </li>-<li>at times the entire rupture and haemorrhage form an organised haematoma and a complex vascular adnexal mass</li>-</ul><h5>CT</h5><ul>-<li>well circumscribed cystic lesion</li>-<li>thick walled cyst (<3 mm) with inhomogeneous contrast enhancement</li>-<li>high attenuation component (45-100 HU)</li>-<li>“fluid-fluid hematocrit” level</li>-<li>hemoperitoneum with free fluid near the source of bleeding can have high attenuation value (60-65 HU), “sentinel clot” and the attenuation of free fluid reduces further from the source</li>-</ul><h4>Differential diagnosis</h4><p>Possible considerations include:</p><ul>-<li>ruptured <a href="/articles/ectopic-pregnancy">ectopic pregnancy</a>: evaluation of <a href="/articles/beta-hcg-1">serum βhCG</a>-levels is necessary to differentiate ruptured corpus luteal cyst from ruptured ectopic pregnancy, which may have a similar presentation </li>-<li>-<a href="/articles/ruptured-ovarian-cyst">ruptured ovarian cyst</a>: no haemoperitoneum</li>- +<p><strong>Ruptured corpus luteal cysts</strong> are one of the commonest causes of spontaneous <a href="/articles/haemoperitoneum">haemoperitoneum</a> in a woman of reproductive age.</p><h4>Clinical presentation</h4><p>Presentation is variable, ranging from completely asymptomatic to severe abdominal pain due to peritoneal irritation.</p><p><strong>Pathology</strong></p><p>The <a href="/articles/corpus-luteum">corpus luteum</a> is a thick-walled cystic structure that is prone to internal haemorrhage, and sometimes peritoneal rupture.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><ul>
- +<li>complex adnexal cyst</li>
- +<li>rim of increased echogenicity surrounding a cystic component</li>
- +<li>free fluid with areas of increased echogenicity representing haemoperitoneum</li>
- +<li>on Doppler, peripheral vascularity may be seen ("<a href="/articles/ring-of-fire-sign-adnexa">ring of fire sign</a>") </li>
- +<li>at times the entire rupture and haemorrhage form an organised haematoma and a complex vascular adnexal mass</li>
- +</ul><h5>CT</h5><ul>
- +<li>well circumscribed cystic lesion</li>
- +<li>thick walled cyst (<3 mm) with inhomogeneous contrast enhancement</li>
- +<li>high attenuation component (45-100 HU)</li>
- +<li>“fluid-fluid haematocrit” level</li>
- +<li>haemoperitoneum with free fluid near the source of bleeding can have high attenuation value (60-65 HU), “sentinel clot” and the attenuation of free fluid reduces further from the source</li>
- +</ul><h4>Differential diagnosis</h4><p>Possible considerations include:</p><ul>
- +<li>ruptured <a href="/articles/ectopic-pregnancy">ectopic pregnancy</a>: evaluation of <a href="/articles/beta-hcg-1">serum βhCG</a>-levels is necessary to differentiate ruptured corpus luteal cyst from ruptured ectopic pregnancy, which may have a similar presentation </li>
- +<li>
- +<a href="/articles/ruptured-ovarian-cyst">ruptured ovarian cyst</a>: no haemoperitoneum</li>
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Image 5 CT (C+ portal venous phase) ( create )
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