Presentation
Acute abdominal pain for one day and afebrile.
Patient Data
A well defined thin-walled fluid attenuating right adnexal lesion with peripheral smooth rim enhancement. A soft tissue attenuating lesion attached to the posterior wall of this lesion which can represent blood clot.
Large degree of high-attenuating ascites in the pelvis, bilateral paracolic gutters and perihepatic region. The attenuation of the ascites ranges from 55 to 65 HU, suggestive of hemorrhagic content.
Left ovary is normal in size without ovarian lesion.
Uterus is retroverted with minimal hydrometra within. No focal enhancing lesion.
Annotated images showed the right adnexal cystic lesion with adjacent soft tissue attenuating lesion (blood clot).
Case Discussion
Patient went on to have diagnostic laparoscopy and intra-operatively found the hemoperitoneum secondary to rupture of right ovarian cyst/corpus luteal cyst.
In the child bearing age women, anyone presented with acute abdominal pain must be considered as ectopic pregnancy until proven otherwise, therefore negative beta hCG/pregnancy test is very crucial.
The other differential diagnoses for cystic adnexal lesion include abscess (tubo-ovarian abscess), cystic neoplasm and endometriomas.
Determine the presence of hemoperitoneum is important for formulating the diagnosis of rupture of hemorrhagic ovarian cyst such as demonstrated in this case.
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