Hemoperitoneum from ruptured cyst in a hyperstimulated ovary: A sonographic mimic of ovarian hyperstimulation syndrome

Abstract

We report a case of a ruptured cyst in a hyperstimulated ovary that was initially misinterpreted as ovarian hyperstimulation syndrome (OHSS). A 22-year-old woman who was on oral clomiphene citrate for primary infertility presented with pain in the lower abdomen, hypotension, and tachycardia. Sonographic examination revealed multiple cysts in both ovaries and free fluid in the abdomen, and the initial diagnosis was OHSS. However, sonographically guided aspiration of free fluid revealed a hemoperitoneum, and the patient underwent emergent surgery. At laparotomy, an actively bleeding ruptured cyst in a hyperstimulated ovary was found to be the cause of the hemoperitoneum. Radiologists must be familiar with the imaging features of this condition to avoid misdiagnosing it as OHSS, because this could potentially delay urgently required surgery.

Sextuplet heterotopic pregnancy presenting as ovarian hyperstimulation syndrome and hemoperitoneum

“…A case report described by Gunabushanam et al (6) exemplified the difficulty of such a diagnosis, as gross hemoperitoneum from the ruptured ovarian cyst was mistaken for ascites-a common finding in OHSS (6). Although close observation and hemodynamic support is appropriate for a stable patient, persistence of symptoms concerning for continued bleeding or rebleeding requires more definitive diagnosis and management.…”

A case of ovarian hyperstimulation syndrome with spontaneous hemoperitoneum

“…In a series by Hertzberg et al of 9 patients with hemoperitoneum who were ultimately diagnosed with ruptured hemorrhagic ovarian cyst, the diagnosis was prospectively made on sonography or computed tomography in only 4 patients (44%). 9 Diagnosis of hemoperitoneum can be done by USG and differentiated from ascites by the presence of echogenic shadows representing blood clots; however, sometimes hemoperitoneum may be anechoic, particularly in the very early or late stages and thus may mimic ascites, 8 In this case, clinical judgment plays a major role in early diagnosis and intervention. The aim of conservative surgical management of the ovaries in these cases is mainly to control the bleeding and preserve ovarian tissue.…”

Abdominal Compartment Syndrome Due to OHSS

“…Despite several factors contributing to increased vascular permeability, the pathophysiology of this syndrome remains unknown [6,7]. Adnexal torsion, rupture of ovarian cysts, hemoperitoneum, thrombotic events, and anesthesia complications may be the consequences of OHSS [8][9][10][11][12]. Abdominal compartment syndrome (ACS) is quite rare considering the ART protocol, but can be fatal [13][14][15].…”