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Case 8

                                                                                           Contributors

                                                                  Dr.Ambika Sunil Gayad, 

                                                                               Dr.Anithraj

Diagnosis

Ruptured Corpus luteal cyst

Radiological Findings, Disease course, and Management

 

                        

  Radiograph of the Chest                   Radiograph of the Abdomen

             (PA)                                            (Erect)

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

Lung fields are clear                         No free air under diaphragm 

Pleural spaces are clear                      No abnormal air fluid levels seen

Heart size within normal limits

Both the diaphragms appear normal

                                                 

 

                      Pelvic Ultrasound (Transabdominal)                                             .

 

 

 

 

 

 

 

 

 

 

Findings

  • Pelvis and right adnexa shows free fluid with internal echoes

  • Mixed echogenic collection is seen surrounding the right ovary which is partially visualized

                    

                 

 

 

 

 

 

 

 

 

 

 

 

 

  Right adnexa shows a complex cyst with internal septations and echoes       closely abutting the right ovary….hemorrhagic cyst

  Color doppler study - Cyst and right ovary show increase in bloodflow

                 

                                                                      

                                      

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

Findings

  • Uterus and left ovary – show normal morphology and  color flow

 

Provisional Diagnosis

  • Complex right adnexal cyst with internal septations closely abutting the right ovary with significant intra-abdominal free fluid  s/o hemoperitoneum

  • Possible differentials: Ruptured ovarian cyst / ruptured ectopic pregnancy.

 

Course

    Laparoscopic  surgery was performed

    Catheterisation of cyst wall done

    Patient discharged once stable

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Final Diagnosis

   

           Ruptured right hemorrhagic corpus luteal cyst

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Discussion

  • Common cause of an emergency in women -acute pelvic pain

  • Bleeding into corpus luteum cyst - common cause of abrupt-onset lower abdominal pain in premenopausal women

  • Increased vascularity in the luteal phase can predispose to cyst rupture

  • Result- haemoperitoneum with increasing, diffuse abdominal pain and              hypotension

  • Ultrasound-primary modality of choice

  • Multidetector CT (MDCT)- Fastest, readily available 

 

Radiological Findings

 

Ultrasonography :

Varying appearances of corpus luteal cysts
  • Less than 3cm
  • Thick wall
  • Peripheral vascularity
  • Irregular contour if ruptured
  • Long standing cyst with hemorrhage within- fine lace like internal                                                          echopattern
  • If ruptured - complex adnexal mass with free fluid and increased echogenic areas s/o hemoperitoneum 

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Colour Doppler US

  • ​May be no vascularity within the cyst or

  • May show low resistance blood flow around the cyst called the hypervascular ''ring of fire"

  • Ruptured cyst may show peripheral vascularity

 

Computed tomography â€‹â€‹â€‹

  • Cyst shows low attenuation values around 25 HU

  • Usually less than 3cm in size

  • Thick walls showing isoattenuation or hyperattenuation 

  • Presence of free fluid 

  • If ruptured

  presence of high attenuation content and

  fluid fluid hematocrit level 

  Hemoperitoneum

 

​MRI

 Round or oval adnexal lesion

  • T1 - homogeneously hypointense

  • T2 - hyperintense

  • T1 C+ (Gd) - intense wall enhancement may be seen 

 

Complications

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Differential Diagnosis 

  • At times difficult to differentiate from tubal ring in an ectopic pregnancy 

In case of ruptured corpus luteal cyst, differential include 

  • Ruptured ectopic pregnancy - evaluate serum Beta HCG levels

  • Ruptured ovarian cyst

 

References

 

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