Ovarian cyst hemorrhage

Case contributed by Ian Bickle


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

Patient Data

Age: 45 years
Gender: Female

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

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 ).


Case Discussion

Hemoperitoneum 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 theater with hemorrhage occurring from a ruptured corpus luteum cyst.

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