Ruptured corpus luteal cysts are one of the commonest causes of spontaneous haemoperitoneum in a woman of reproductive age.
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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 haemoperitoneum
- 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 haematocrit” level
- 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
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