Endometrioma

Case contributed by Dr Mostafa El-Feky

Presentation

Periodic pelvic pain

Patient Data

Age: 40 years
Gender: Female

A left ovarian homogeneous rounded lesion with smooth outline, suggestive of left ovarian cyst.

A left-sided ovarian cyst is noted 5 cm in average diameter, with focal dependent eccentric dark T2 nodule. It shows T1 hyperintensity not suppressed on fat sat, with T2 shading. It shows a thin wall with mild enhancement and no mural soft tissue component. No diffusion restriction.

Case Discussion

MRI features are consistent with left-sided endometriotic (chocolate) cyst. T2 dark spot sign is demonstrated,  which indicates chronic hemorrhage, differentiating endometriotic cyst from a functional hemorrhagic ovarian cyst, as both show high T1 signal with T2 shading

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