Presentation
Chronic pelvic pain.
Patient Data
Large well-defined biilocular cyst prolapsed in Douglas pouch with a homogeneous "ground-glass" echotexture.
Unilocular left ovarian cyst of homogeneous hypoechoic fluid content.
A large well-defined right ovarian cystic mass prolapsed in Douglas pouch displacing the ovarian follicles peripherally. It elicits a high signal on T1, T1 fat sat with T2 shading sign, containing a rounded nodule of a low signal on T2 sequences "T2 dark spot sign". No enhancement seen on postcontrast sequences.
Left unilocular ovarian cyst (4.5 cm) of low signal on T1 and high signal on T2 with peripheral enhancement (most likely functional cyst).
Annotated image: the green arrow indicates the T2 dark spot sign (small hypintense nodule against the cyst wall, result of chronic hemorrhage).
Case Discussion
Ultrasound and MRI features of a large right ovarian endometrioma prolapsed in Douglas pouch with T2 dark spot sign.
T2 dark spot sign is specific for chronic hemorrhage and is helpful in diagnosing a solitary endometrioma from a functional hemorrhagic ovarian cyst, as both might show high T1 signal with T2 shading.
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