Presentation
Sudden onset of abdominal pain. Pregnancy test was negative.
Patient Data
Mixed density mass with some solid and cystic components in the left adnexa, with uniform high-attenuation blood clot in the pouch of Douglas. The left adnexal lesion is likely to be a ruptured corpus luteum cyst. High-attenuation free fluid throughout the abdomen and pelvis in keeping with hemoperitoneum.
The left ovarian vein is distended (axial and sagittal), and there is a normal variant circumaortic left renal vein (axial and sagittal). The posterior branch of the circumaortic left renal vein is compressed, and this is the branch that the distended left ovarian vein drains into.
Appendectomy clips are noted in the right iliac fossa.
Case Discussion
In women of reproductive age with abdominal pain and spontaneous hemoperitoneum, two differentials must be considered: ruptured ectopic pregnancy or ruptured corpeus luteum cyst. To differentiate between these two diagnoses, a β-hCG test is useful as a negative result would exclude ectopic pregnancy.
Another interesting finding in this case relates to the venous anatomy. The left ovarian vein drains into the left renal vein; in this case draining into the posterior branch of a circumaortic left renal vein, which is compressed posterior to the aorta. This may account for the left ovarian vein distension.
This case was managed conservatively, hence there is no follow-up imaging available.
This case was uploaded with assistance from Dr Vikas Shah.