Sonography of hemorrhagic ovarian cysts

Abstract

The sonographic appearance of hemorrhagic ovarian cysts (HOC) has received little attention aside from a recent report in adolescent girls. We reviewed the sonographic findings in 14 adults with 15 pathologically proven HOC to see whether there were any consistent sonographic findings that, along with the clinical history, might make possible the diagnosis. The majority (93%) of patients presented with the abrupt onset of lower abdominal or pelvic pain, and each, when clinically appropriate, had a negative serum pregnancy test. Sonographically, all of the masses were cystic except one. The cyst wall was thin and well defined in six cases and thick and irregular in eight. The majority (87%) had internal echoes. These echoes were scattered and low level or diffuse and homogeneous (27%) or complex and echogenic (53%) in nature. Two cysts had numerous septations, and another had a fluid--debris interface. If the pain subsides and the hematocrit remains stable, the premenopausal patient can be managed conservatively. Sonographic follow-up is recommended so that an underlying hemorrhagic ovarian cystic neoplasm can be excluded. This was present in three of our patients, two of whom were postmenopausal.

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

“…Despite contentions that the offending cyst is often not found [2], a vestige of the ruptured cyst was seen in most patients in our study. If not seen at transabdominal ultrasound, an ovarian cyst or its remnant should be sought at endovaginal sonography in a woman of childbearing age who presents with a large hemoperitoneum.…”

“…The etiology for cyst rupture is not known, although it has been suggested that the increased vascularity of the ovary in the luteal phase may predispose to rupture of a corpus luteal cyst [6]. Although the sonographic appearance of the contained hemorrhage within an ovarian cyst has been well described [1][2][3][4][5], the imaging findings associated with cyst rupture and hemorrhage have not been similarly described in the literature. Consequently, patients with a ruptured ovarian cyst are frequently misdiagnosed with unrelated gynecologic, urologic, or gastrointestinal disorders both before and after imaging evaluation [6,7].…”

“…Indeed, the hemorrhagic ovarian cyst has been termed "the great imitator" [3]. Common sonographic patterns include a fluid-containing mass with a thick rim, internal strands and septations, internal echoes, a fluiddebris level, or a homogeneously hyperechoic mass [1][2][3][4][5].…”

“…Although the ultrasound findings of a "hemorrhagic ovarian cyst" have been well described, less attention has been given to the imaging findings produced when the bleeding is not contained in the ovary but rather extravasates into the pelvis and abdominal cavity [1][2][3][4][5]. Such a rupture and hemorrhage of an ovarian cyst is potentially catastrophic for the patient and is often misdiagnosed [6 -9].…”

Variable MR findings in ovarian functional hemorrhagic cysts

“…are usually diagnosed on ultrasound (US); the follow-up examination, showing the disappearance of the lesion, is usually sufficient to confirm the diagnosis (1)(2)(3)(4). Magnetic resonance (MR) imaging is rarely performed, because it is only done in case of an associated pathology, suspected complication, or an atypical aspect on US.…”