Case contributed by Shailaja Muniraj
Diagnosis certain


Chronic intermittent pelvic pain. Dysmenorrhea.

Patient Data

Age: 25 years

The right ovary appears bulky with a posterior cystic lesion that appears hyperintense on T1 and intermediate on T2 (shading sign). No signal intensity loss noted on T1 fat sat images. The variable restriction is seen on DWI/ADC images.  These features suggest an endometriotic cyst.

Another small adjacent cyst is seen, appearing subtly hyperintense on T1 and hyperintense on T2. Signal intensity loss noted on T1 fat sat images. No restriction on DWI/ADC images. These features suggest a hemorrhagic ovarian cyst.

Also, the anterior-most cyst is a follicular ovarian cyst.

The uterus, endometrium, and left ovary show normal imaging features.

This patient was a known case of endometriotic cyst on follow up.

Special thanks: Dr. Nanda Kumar K

Case Discussion

This case shows the classic appearance of endometrioma vs hemorrhagic cyst.

The radiologist can try able to differentiate these two entities on MRI by the following features:

  • endometriotic cyst
    • T2 shading sign
    • persistent signal on  fat-saturated images
    • variable restriction on DWI/ADC images
  • hemorrhagic cyst
    • T2 hyperintense
    • signal loss on fat-saturated images
    • no restriction on DWI/ADC images.


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