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Shading sign - endometrioma

Case contributed by Dr MT. Niknejad

Presentation

Pelvic pain.

Patient Data

Age: 30 years
Gender: Female
MRI

A 65×50×53 mm thick walled cystic lesion with T2 shading is present at right adnexa, posteromedial to the right ovary which shows mild peripheral enhancement on post contrast images most consistent with endometrioma.

Two thin walled cysts are also observed at right and left ovaries measuring 27 mm and 29 mm, respectively. Both of them are low signal on T1WI and high signal on T2WI without obvious contrast enhancement inferring simple cysts.

A tiny amount of free fluid is present in the pelvis. 

Case Discussion

The patient underwent laparoscopic cystectomy, and histopathology evaluation confirmed endometrioma.

The shading sign is typically seen in endometrioma and may also be seen with some endometrioid tumors. It is a highly sensitive and specific sign to distinguish endometriomas from other blood-containing lesions such as hemorrhagic cysts.

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