Massive ovarian oedema (MOO) is a very rare disease characterized by a tumour-like enlargement of the ovary.
It characteristically presents in young women ~ 6 to 33 years (mean age ~21 years 5).
Most patients present with intermittent pelvic pain of several months duration +/- an adnexal mass. Abnormal uterine bleeding, elevated androgens and abdominal distension can be occasionally seen
The most probable cause is thought to be recurrent partial torsion of the mesovarium, with obstruction to the venous and lymphatic returns; on the other hand, the basic process may be stromal hyperplasia or hyperthecosis, while the oedema is a secondary phenomenon, probably due to torsion of an abnormal, already enlarged organ.
- Meig syndrome
- precocious puberty in infants due to MOO has been described in the literature 5
Location - laterality
It is almost always unilateral and in ~ 2/3rd of cases involve the right side
The imaging features correspond to the degree of torsion and oedema.
May appear like a hypoechoeic, hypovascular solid ovarian mass like lesion; there is presence of central increased ovarian stroma and there are multiple follicles arranged in the peripheral cortex.
MRI may also demonstrate an enlarged ovarian mass like lesion.
Described signal characteristics include 5
- T1: hypointense
- T2: hyperintense
- T1 C+ (Gd): may show enhancement
- ovarian fibromatosis - from long standing massive ovarian oedema 5
History and etymology
The term massive ovarian oedema was first described by Kalstone in 1969.
Treatment and prognosis
Management options include oophoropexy and occasionally oophorectomy is also considered.
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- 2. Lee AR, Kim KH, Lee BH et-al. Massive edema of the ovary: imaging findings. AJR Am J Roentgenol. 1993;161 (2): 343-4. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Hall BP, Printz DA, Roth J. Massive ovarian edema: ultrasound and MR characteristics. J Comput Assist Tomogr. 17 (3): 477-9. - Pubmed citation
- 4. Eurorad teaching files : Case 1323
- 5. Coakley FV, Anwar M, Poder L et-al. Magnetic resonance imaging of massive ovarian edema in pregnancy. J Comput Assist Tomogr. 34 (6): 865-7. doi:10.1097/RCT.0b013e3181efdfaa - Pubmed citation
- 6. Lalwani N, Patel S, Ha KY et-al. Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review. Br J Radiol. 2012;85 (1013): 477-86. Br J Radiol (full text) - doi:10.1259/bjr/92819127 - Free text at pubmed - Pubmed citation