Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis

Abstract

A ruptured ovarian cyst can produce massive hemoperitoneum, with clinical symptomatology and sonographic features that closely mimic those of other disorders, in particular ectopic pregnancy. Considering the likelihood of both clinical and radiologic misdiagnosis, the radiologist should consider and pursue the diagnosis of a ruptured hemorrhagic ovarian cyst in a woman of child-bearing age who presents with pelvic pain and a large amount of complicated intraperitoneal fluid.

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

“…In a series of 9 patients with hemoperitoneum who were ultimately diagnosed to have a ruptured hemorrhagic ovarian cyst, the diagnosis was prospectively made on sonography or CT in only 4 (44%) patients. 7 Two patients were misdiagnosed as ectopic pregnancy, and in another 3 patients only a broad differential diagnosis of complicated intraperitoneal fluid was put forward. In the same series, the diagnosis was initially considered by the referring clinician in only 2 (22%) patients.…”

“…7 It is important to distinguish the OHSS from a ruptured cyst, because a ruptured cyst with hemoperito- neum requires immediate operative management, whereas OHSS is nearly always managed conservatively. Clinically, patients who have OHSS may present with pain; a distended, tender abdomen; and signs of hypovolemia (tachycardia, low blood pressure, and shock), all of which are also associated with a ruptured ovarian cyst or ectopic pregnancy with hemoperitoneum.…”

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.…”

Ovarian salvage in bilaterally complicated severe ovarian hyperstimulation syndrome

“…The incidence of ovarian torsion after IVF treatment has been reported to range from 0.08% to 0.2% (1,3). OHSS, particularly if associated with pregnancy, may be by itself a risk factor for ovarian torsion (2).Cyst rupture is a critical complication of the hyperstimulated ovary; its incidence after IVF is 0.1% (1), and it is often misdiagnosed (4).…”