Endometrioma - shading sign

Case contributed by Mohammad Taghi Niknejad
Diagnosis certain

Presentation

Pelvic pain and dysmenorrhea.

Patient Data

Age: 25 years
Gender: Female
mri

A 74× 33 mm cystic lesion is noted in the right adnexa that is hyperintense on T1WI and hypointense on T2WI inferring the shading sign and suggestive of endometrioma. The right ovary couldn’t be defined separately from the mentioned cystic lesion.

A small volume of free fluid is present in the pelvic spaces.

Case Discussion

The shading sign in the MRI of a pelvic cystic lesion highly suggests an endometrioma.

It may also be seen with endometrioid carcinoma of the ovary and, uncommonly, other blood-containing lesions such as hemorrhagic corpus luteum cysts.

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