Hemorrhagic ovarian cyst

Case contributed by Dr Ammar Haouimi

Presentation

Three days history of left-sided pelvic pain

Patient Data

Age: 15 years
Gender: Female
Ultrasound

There is a well-defined left ovarian mass of complex echotexture, predominately echogenic with fluid component, and posterior acoustic enhancement. No internal blood flow is seen on color Doppler.

MRI

The previously described mass appears well-circumscribed of centro-ovarian location of intermediate signal intensity on T1WI with areas of high signal, high signal intensity on T2WI with fluid-fluid level (the hypointense sediment indicates blood products), and hypointense wall (subacute stage with hemosiderin deposition at the wall). The postcontrast sequences show regular peripheral enhancement. 

Both ovaries show numerous small follicles with minimal effusion in the Douglas pouch.

Case Discussion

Ultrasound, and MRI features of hemorrhagic ovarian cyst.

The main differential diagnosis in such cases is an ovarian endometrioma

  • Usually contains uniform low-level internal echoes with a hypervascular wall on Doppler ultrasound.
  • on MRI, it shows high signal on T1 and low signal on T2 (shading sign), although there is overlap in appearance with hemorrhagic cysts.
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Case information

rID: 68931
Published: 20th Jun 2019
Last edited: 20th Jun 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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