Ovarian endometriomas

Case contributed by Mohamed Saber
Diagnosis almost certain


Lower abdominal pain and vaginal bleeding.

Patient Data

Age: 35 years
Gender: Female

Both ovaries are enlarged and located nearby, touching each other in the midline giving the "kissing ovaries sign". Both ovaries show multiple variable-sized cysts, most of them elicit high signal in T1& T1 fat sat, and low signal on T2 " shading sign" with fluid/ fluid levels. Some lesions elicit high signal in T1 & T2 and some show a spot of low signal on TWI "T2 dark spot sign". Minimal peripheral enhancement is noted in the post-contrast study.

Annotated image

Annotated images highlight the MRI signs of ovarian endometriomas.

Case Discussion

Here is a case of bilateral ovarian extensive endometriomas with associated three MRI signs:

Kissing ovaries sign is most frequently associated with the severe form of pelvic endometriosis, in which repeated bleeding causes adhesions with pulling of the ovaries toward the midline.

Shading sign refers to T2 hypointensity of the endometrioma owing to the presence of deoxyhemoglobin and methemoglobin which is very suggestive of endometrioma. 

T2 dark spot sign is specific for chronic hemorrhage and helps diagnose endometriomas.

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