Ovarian cyst haemorrhage

Case contributed by Dr Ian Bickle

Presentation

Middle aged female recently commenced on warfarin for thrombotic stroke. Acute lower abdominal pain. No trauma.

Patient Data

Age: 43
Gender: Female
CT

Moderate volume high attenuation free fluid in the pelvis and upper abdomen, in keeping with haemoperitoneum.

Mixed attenuation cystic right ovarian mass, with evidence of associated active contrast extravasation.

Annotated image

Active contrast extravasation from the ruptured right ovarian cyst ( red arrow ).

Haemoperitoneum.

Case Discussion

Haemoperitoneum may occur for a multitude of reasons, with CT imaging ( multiphase with high contrast flow rates ) being the typical initial investigation of choice.

It is important to try and establish:

1.  The source of the bleeding

2.  The status of the bleeding - is it active at the time of scanning? 

This is identified by observing the presence of active contrast extravasation ( ' the squirter' as our surgical colleagues would say ).

This patient proceeded to theatre with haemorrhage occurring from a ruptured corpus luteum cyst.

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Case information

rID: 37654
Case created: 16th Jun 2015
Last edited: 25th Jan 2016
System: Gynaecology
Inclusion in quiz mode: Included

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