Ruptured ovarian hemorrhagic cyst


This patient initially had an ultrasound done which identified a right para-ovarian complex cyst with features of hemorrhage. MRI was immediately done in view of cyst complexity and pain patient was undergoing. MRI not only helps in clearly identifying the cyst location ( ovarian vs para-ovarian), but also a detailed characterization even in the absence of i.v. gadolinium contrast. 

The dependent T2 hypointense hemorrhagic organizing clot within the otherwise clear cyst and the evidence of organizing clot in the free fluid in cul-de-sac confirms the diagnosis. 

Cysts larger than 3 cm tend to be more symptomatic. Usually nothing more is warranted other than symptomatic management and follow up ultrasound after six to eight weeks to reassess the ovary. 

A common differential to keep in mind is an ectopic pregnancy and asking for a pregnancy test in a sexually active woman is recommended.