DOI:10.2214/AJR.06.0874
AJR 2007; 188:W392
© American Roentgen Ray Society
MDCT Findings of Active Bleeding from the Ovarian Cyst Wall
Diana Kaya,
Mithat Haliloglu and
Musturay Karcaaltincaba
Hacettepe University School of Medicine, Ankara 06100,
Turkey
WEB—This is a Web exclusive article.
Note—We thank Saniye Ekinci for her clinical contribution.
A 15-year-old girl with a history of aplastic anemia was referred to our
pediatric surgical unit with the presumptive diagnosis of intraabdominal
hemorrhage. She presented with a sudden onset of severe abdominal pain in the
left lower quadrant. She was taking methyl prednisolone and cyclosporine for
treatment of aplastic anemia. Physical examination revealed a body temperature
of 37.6°C, blood pressure of 90/60 mm Hg, and tachycardia of 130 beats per
minute. There was abdominal tenderness in the left lower quadrant with
guarding. A complete blood count revealed hemoglobin, 6.6 g/dL; WBC,
400/µL; and platelet count, 17.000/µL.
Sonography revealed a large amount of intraabdominal fluid and a
hyperechogenic left ovarian cyst measuring 7 x 5 x 4 cm.
Subsequently, a CT examination was performed using a 16-MDCT scanner
(Sensation, Siemens Medical Solutions). The technical parameters were detector
configuration, 16 x 1.5 mm; pitch, 1.5; detector collimation, 1.5 mm;
slice thickness, 5 mm; reconstruction index, 5 mm. For coronal reformations,
thin axial images were reconstructed from the raw data with a slice thickness
of 2 mm and a reconstruction index of 1 mm.
Active bleeding was identified on axial images from the wall of the left
ovary (Fig. 1A,
1B). CT attenuation values of
free peritoneal fluid measured in the pelvic region and upper abdominal left
quadrant were 45 and 25 H, respectively. The patient was operated on based on
the radiologic findings. Laparotomy was performed and 1,500 mL of blood was
aspirated from the peritoneal cavity. There was active bleeding from the left
ovarian cyst wall. The left ovary was totally excised. There was no evidence
of ovarian rupture or torsion, and there was no other source of bleeding in
the abdominal and pelvic cavity. The patient's postsurgical course was
uneventful. Pathologic examination revealed hemorrhagic follicular cysts lined
with theca cells and primordial cysts of the ovary.
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Fig. 1B —15-year-old girl with left lower abdominal quadrant pain.
Reconstructed coronal contrast-enhanced MDCT image shows active extravasation
(arrow) to better extent than transverse contrast-enhanced MDCT image
(A). Note massive ascites.
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The rupture of an ovarian cyst is one of the most frequent causes of
hemoperitoneum in young women. Sonography is the initial imaging technique in
patients with acute pelvic pain. When sonography findings are equivocal for
diagnosis, further evaluation with CT is advocated. CT provides useful
information about abdominal fluid density differences in the pelvic cavity and
upper abdomen and direct signs of cyst wall rupture, such as the irregularity
of opacified cystic wall and extravasation of intravascular contrast material
[1]. The presence of a jet of
extravasated contrast material as an indicator of active bleeding has been
described using CT in children with thoracoabdominal trauma
[2]. In a series conducted by
Willmann et al. [3], active
hemorrhage in patients who had sustained blunt abdominal trauma was most
frequently visible as a jet of extravasated contrast agent using
contrast-enhanced MDCT.
To our knowledge, MDCT findings of active bleeding from the ovarian cyst
wall have not been described previously. MDCT is helpful to show the active
extravasation from an ovarian cyst.
References
- Hertzberg BS, Kliewer MA, Paulson EK. Ovarian cyst rupture causing
hemoperitoneum: imaging features and the potential for misdiagnosis.
Abdom Imaging 1999;24
: 304-308[CrossRef][Medline]
- Taylor GA, Kaufman RA, Sivit CJ. Active hemorrhage in children
after thoracoabdominal trauma: clinical and CT features.
AJR 1994; 162:401
-404[Abstract/Free Full Text]
- Willmann JK, Roos JE, Platz A, et al. Multidetector CT: detection
of active hemorrhage in patients with blunt abdominal trauma.
AJR 2002; 179:437
-444[Abstract/Free Full Text]
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