Case contributed by Mostafa Elfeky
Diagnosis almost certain


Pelvic pain.

Patient Data

Age: 17 years
Gender: Female

Left ovarian cyst with regular wall and high T1 signal that is accentuated on T1 fat suppressed sequence. It shows a mild homogeneous decreased T2 signal (shading sign). There is marked hypointense content on T1 and T2 at the posterior dependent aspect of the cyst (T2 dark spot sign).

Case Discussion

MRI features are in keeping with left ovarian endometrioma, showing shading sign appears as homogeneous mild decreased T2 signal as one of its patterns and T2 dark spot sign which has high specificity to endometriomas.

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