Ovarian endometriomas (kissing ovaries sign)
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Chronic pelvic pain.
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Both ovaries are enlarged and located in close proximity, touching each other in the pouch of Douglas giving the kissing ovaries sign.
The right ovary shows unilocular cysts (largest measures 5.4 x 4.3 x 4 cm), as well as a small cystic lesion (2.5 x 2.2 x 1 cm) of high signal on T1/T1 fat, sat, low signal on T2 with no enhancement on postcontrast sequences in keeping with endometrioma.
The left ovary shows also a cystic lesion (4.8 x 4 x 35 cm) of high signal on T1/T1 fat sat, low signal on T2 with no enhancement on postcontrast sequences in keeping with endometrioma.
Normal appearance of the uterus.
MRI appearances of bilateral ovarian endometriomas with a kissing ovaries sign.
The kissing ovaries sign is most frequently seen in the severe form of pelvic endometriosis, The repeated bleeding causes adhesions with pulling off the ovaries toward the midline. It may be seen in pelvic inflammatory disease such as pyosalpinx and pelvic abscess.