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
Modality: 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.

Modality: 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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