Ovarian endometrioma

Case contributed by Dr Mostafa El-Feky


Pelvic pain. Previous ultrasound revealed left ovarian cyst since 2 months.

Patient Data

Age: 30 years
Gender: Female

The left ovary shows one large cystic lesion measuring 4.1 x 3.6 cm with homogenous diffuse hypoechoic fluid content and fine low-level echoes. It also shows dependent echogenic focus.

Right ovary shows Intraovarian cystic lesion with isoechoic texture and peripheral echogenic foci. It is measuring 2.9 x 2.6 cm.


Bilateral T1 hyperintense adnexal cysts showing T2 shading measuring 3.3 x 3.9 cm on the left side and 2.3 x 2.2 cm on the right side. They are showing blooming foci on SWI sequence and leveling diffusion restriction. 

Case Discussion

This case represents bilateral ovarian cyst with a different appearance on ultrasonography and MRI. On ultrasonography, the large one shows fluid content, however, with mildly altered echogenicity and the small right one is isoechoic. Ovarian cystic lesions with altered fluid content are considered complicated cysts and need further investigations, preferably with MRI.

T1 hyperintense cysts with no suppression at T1 fat sat are representing a hemorrhagic cyst differentiating it from mature cystic teratoma. The T2 criteria of the cysts are suggestive of chronic hemorrhagic cysts (ovarian endometriomas) with the T2 shading sign, seen on the left ovarian cyst, and complete hypointense signal as seen on the right one. T2 dark spot sign is also noted at both cysts and is considered more specific sign for endometriomas than T2 shading sign 1

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Case information

rID: 65591
Published: 15th Jan 2019
Last edited: 17th Jan 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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