Diagnostic imaging of ovarian endometrioma rupture with hemoperitoneum

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Abstract

An endometrioid ovarian cyst (known as endometrioma) is the most common variant of external endometriosis. Clinical symptoms range from asymptomatic to negatively affecting on quality of life and daily activities of a reproductive age woman. Rupture of an endometrioid cyst with hemorrhage into the abdominal cavity occurs in 3% of women with this pathology, which is a rare complication.

Ruptured endometrioid cysts may present a diagnostic and surgical challenge: patients may have acute abdominal symptoms and hemodynamic instability, also imaging of a ruptured endometrioid cyst may mimic ovarian malignancy. Therefore, the emergency radiologist needs to know the semiotics of an endometrioid cyst with rupture and hemorrhage into the abdominal cavity.

We represent the clinical case of a prime diagnosed large endometrioid cyst in a 32-year-old patient, complicated by hemorrhage in the abdominal cavity. In the emergency department, the patient underwent native computed tomography and ultrasound investigation.

Based on the study of Russian and foreign literature, the review was made about main aspects of radiation semiotics of endometrioid cysts with rupture and hemorrhage in the abdominal cavity and about of differential diagnosis of rupture of endometrioid cysts with ruptures of functional cysts and malignant cystic ovarian formations.

About the authors

Vladimir V. Ryazanov

Saint Petersburg State Pediatric Medical University; Military Medical Academy

Email: 79219501454@yandex.ru
ORCID iD: 0000-0002-0037-2854
SPIN-code: 2794-6820

M.D., D.Sc. (Medicine); Assotiated Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Gulnaz K. Sadykova

Saint Petersburg State Pediatric Medical University; Military Medical Academy

Email: kokonya1980@mail.ru
ORCID iD: 0000-0002-6791-518X
SPIN-code: 3115-7430

M.D., Ph.D. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Igor S. Zheleznyak

Military Medical Academy

Email: igzh@bk.ru
ORCID iD: 0000-0001-7383-512X
SPIN-code: 1450-5053

M.D., D.Sc. (Medicine); Professor

Russian Federation, Saint Petersburg

Igor V. Boykov

Military Medical Academy

Email: qwertycooolt@mail.ru
ORCID iD: 0000-0001-9594-9822
SPIN-code: 1453-8437

M.D., D.Sc. (Medicine); Professor

Russian Federation, Saint Petersburg

Victor V. Ipatov

Military Medical Academy

Email: mogidin@mail.ru
ORCID iD: 0000-0002-9799-4616
SPIN-code: 2893-9880

M.D., Ph.D. (Medicine)

Russian Federation, Saint Petersburg

Roman A. Postanogov

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: r.a.postanogov@yandex.ru
ORCID iD: 0000-0002-0523-9411
SPIN-code: 8686-1597

M.D., Assistant

Russian Federation, Saint Petersburg

References

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Supplementary files

Supplementary Files
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1. JATS XML
2. Figure 1. Native axial CT scan (a) and transabdominal sonogram (b) show free fluid around the liver (arrow). Native CT images in the sagittal plane (c, d) and transvaginal sonogram (e) show blood as free fluid in the uterovesical space (circle) and in the uterorectal space (asterisk). An endometrioid cyst (zipper) is visualized on CT scans (c, d), transvaginal sonogram (e). CT scan (d) shows X-ray attenuation coefficients in Hounsfield units in an endometrioid cyst and in free fluid in the pelvic cavity. Infiltration of the greater omentum on the right (dashed arrow) on a CT scan in the frontal plane (f)

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3. Figure 2 Native axial CT scan (a) and transabdominal sonogram (b) show the right ovary with an endometrioid cyst (arrow) and the left ovary containing a follicle (dashed arrow)

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4. Figure 3. On native CT scans in the axial plane (a, b), clots are adjacent from the outside in the place of the greatest thickening of the cyst walls (arrow) (dashed arrow). Similar transabdominal sonogram (c)

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5. Figure 4. Transvaginal sonograms (a, b) show an identical sonographic pattern of fluid in the endometrioid cyst (arrow) and free fluid in the uterovesical space (circle) and in the utero-rectal space (asterisk)

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