Uterine fibroids and bilateral endometriomas

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis almost certain


Chronic pelvic pain, primary infertility and intermittent vaginal bleeding.

Patient Data

Age: 40 years
Gender: Female

Enlarged uterus measuring about (10.5 x 9.2 x 10 cm at its AP, TV, and CC dimensions) presenting multiple variable-sized well defined focal lesions/ masses attaining sub-serous &intramural locations, eliciting intermediate to low signal at T1 and low signal at T2 pulse sequences with minimal enhancement in post-contrast study as well as the characteristic whorly appearance. The largest is in anterior uterine intra-mural location measures about 5.1 x 4.6 cm, some of them showing small areas of non-enhanced cystic degenerations.

Left adnexal likely ovarian cystic lesion is noted measuring about 9.7 x 7.3 cm at max. diameters with slightly thickened wall, eliciting high T1 and intermediate to low T2 (shading artifact) as well as not suppressed at FAT SAT images and no enhancement at post-contrast series except for mild mural enhancement.

Moreover, right ovarian bilocular cysts one of them is a simple cyst (of low T1, bright T2 with no enhancement detected),the other cyst is seen measuring about 3.7 x 3.2 cm eliciting high T1 and intermediate to low T2 (shading artifact) as well as not suppressed at FAT SATR images.

No pelvic fluid collection detected.

Case Discussion

MRI study shows multiple uterine fibroids and bilateral ovarian endometrioma cysts (chocolate cysts) with T2 shading. The close proximity of both ovaries is known as "kissing ovaries" which is caused by adhesions and is considered a sign of pelvic endometriosis.

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