Ultrasound‐guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic untwisting of ovarian torsion

Abstract

Hyperreactio luteinalis (HL) is characterized by multicystic bilateral enlargement of the ovaries and is a self- CASE REPORTA 33-year-old woman, gravida 3 para 2, presented at the emergency room of our hospital owing to acute abdomen. Transabdominal ultrasound examination (TAS) revealedCorrespondence to: Dr Y. Sato, Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu 520-8511, Shiga, Japan (e-mail: yukiyasu@kuhp.kyoto-u.ac.jp) Accepted: 17 March 2015bilateral multicystic tumors occupying the pelvic cavity, and the patient was subsequently admitted to the obstetrics and gynecology department. The patient's third pregnancy had ended, 9 days previously, in fetal demise at 24 weeks' gestation caused by hydrops fetalis associated with cystic hygroma (karyotype was normal 46,XX). On the 2 nd day postpartum, she had been discharged from the hospital with unremarkable transvaginal ultrasound findings.On admission to the obstetrics and gynecology department, the patient's lower abdomen was slightly distended and she had severe pain and tenderness, which were dominant on the left side. Subsequent blood testing found elevated white blood cell (WBC) count (12 900/μL), C-reactive protein (CRP) (0.7 mg/dL) and D-dimer (15.8 μg/mL) levels. Magnetic resonance imaging (MRI) confirmed bilateral ovarian multicystic enlargement, reaching more than 10 cm in diameter (Figure 1a). Aggregation of coiled tubular structures, which was considered to represent twisted and congested blood vessels, was observed between the uterus and the left ovarian tumor (Figure 1a). Some of these blood vessels contained nodules of low signal intensity, suggestive of intravenous clot formation. On T1-weighted MRI, the septa and surface of the left ovarian tumor were poorly enhanced by gadolinium, as compared with the right side (Figure 1b). From these observations, the patient was diagnosed with hyperreactio luteinalis (HL) complicated by torsion of the enlarged left ovary. Serum levels of β-human chorionic gonadotropin (β-hCG) and testosterone were 1550 mIU/mL and 3.22 ng/mL, respectively, both of which were consistent with the values recorded 9 days postpartum.Emergency laparoscopic detorsion of the ischemic left ovary was planned. Aiming to reduce the risk of cystic injury and bleeding at the trocar insertion site, volume reduction of the left ovarian tumor was performed by ultrasound-guided percutaneous transabdominal aspiration of the cyst. About 200 mL of thin yellow serous fluid was removed from three cystic components through

Giant cyst in heterotopic pregnancy: A case report

“…If complications such as ovarian torsion do not occur, they can be observed until 6 mo after the end of pregnancy, when most will spontaneously disappear. If ovarian torsion occurs and surgery is necessary, conservative surgery can be performed in order to minimize ovarian damage and to ensure the pregnancy continues before full term[ 11 ]. In this reported case, theca lutein ovarian cyst with pedicle torsion could not be ruled out by ultrasound, but guided needle ovarian cyst aspiration could be performed on the patient to relieve symptoms.…”

Unrecognized Primary Hypothyroidism As a Possible Cause of Hyperreactio Luteinalis

“…Common indications, at present, for surgical intervention include an undue suspicion of malignancy or the presence of acute complications such as torsion, rupture of cysts or hemoperitoneum [19]. Ultrasound-guided percutaneous aspiration of cysts has been performed in the past as a measure to avoid surgery for torsion [20]. However, in our patient, due to significant respiratory distress, we performed emergency open laparotomy with aspiration of cysts.…”