Chocolate cyst (endometrioma) and focal uterine adenomyosis

Case contributed by Anil Kumar Geetha Virupakshappa
Diagnosis certain


Abdominal pain and irregular cycles

Patient Data

Age: 30 years
Gender: Female

A well-defined large T1 hyperintense and T2 hypointense cyst with T2 shading sign measuring 9.3 x 6.2 x 7.2 cm is noted involving the right ovary. Thin internal incomplete septation is noted. No rupture or any other complication.

Bulky posterior uterine wall with multiple T1 hyperintense foci is noted suggestive of focal adenomyosis. Rest of the uterus is normal in size and signal intensity. The endometrium appears normal.

Left ovary is normal in size and signal intensity.

There is no involvement of bowel loops by endometrioma. No adhesions.

Few tiny parietal peritoneal T1 hyperintense foci suggestive of endometriotic deposits are noted in the region of pouch of Douglas

Minimal free fluid is seen.

Case Discussion

T2 hypointensity of the cyst is due to presence of deoxyhemoglobin and methemoglobin, called T2 shading sign suggests endometrioma.

Focal uterine wall thickening with T1 hyperintense foci indicative of menstrual hemorrhage into the ectopic endometrial tissues in cases of adenomyosis.

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