Ruptured corpus luteal cysts are one of the commonest causes of spontaneous hemoperitoneum in a woman of reproductive age.
Presentation is variable, ranging from completely asymptomatic to severe abdominal pain due to peritoneal irritation.
The corpus luteum is a thick-walled cystic structure that is prone to internal hemorrhage, and sometimes peritoneal rupture.
- complex adnexal cyst
- rim of increased echogenicity surrounding a cystic component
- free fluid with areas of increased echogenicity representing hemoperitoneum
- on Doppler, peripheral vascularity may be seen ("ring of fire sign")
- at times the entire rupture and hemorrhage form an organized hematoma and a complex vascular adnexal mass
- well circumscribed cystic lesion
- thick walled cyst (<3 mm) with inhomogeneous contrast enhancement
- high attenuation component (45-100 HU)
- “fluid-fluid hematocrit” level
- 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
Possible considerations include:
- 1. Choi HJ, Kim SH, Kim SH et-al. Ruptured corpus luteal cyst: CT findings. Korean J Radiol. 2003;4 (1): 42-5. Free text at pubmed - Pubmed citation
- 2. Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008;28 (6): 1645-59. doi:10.1148/rg.286085504 - Pubmed citation