Hemorrhagic ovarian cyst
Updates to Synonym Attributes
Updates to Article Attributes
Body
was changed:
Haemorrhagic ovarian cysts usually (HOC) usually result from haemorrhage into a corpus luteum or other functional cyst. Radiographic features are variable depending on the age of the hemorrhage. They typically resolve within eight weeks.
Clinical presentation
Patients may present with sudden-onset pelvic pain, pelvic mass, or they may be asymptomatic and the HOC is an incidental finding 4.
Pathology
HOCs typically develop as a result of ovulation. Secondary to a hormone response the stromal cells surrounding a maturing graafian follicle become more vascular, and after the oocyte has been expelled, the graafian follicle develops into a corpus luteum with a highly vascular and fragile granulosa layer, which ruptures easily forming a HOC 4.
Radiographic features
Ultrasound
TheyHOCs can have a variety of appearances depending on the stage of evolution of the clot. The most typical appearances are that of lace-like reticular echoes or an intracystic solid clot.
There should not be any internal blood flow, however circumferential blood flow in the cyst wall is typical. Clot may adhere to cyst wall mimicking a nodule, but has no blood flow on Doppler imaging.
Pelvic MRI
Relatively well defined cystic lesion in association with the ovary. Signal characteristics can vary depending on the age of the haemorrhage. In an acute setting
-
T1:
- highhigh signal -
T1 C+ (Gd):
- nono enhancement -
T2:
- lowlow signal - haemorrhage evolves from the center of the cyst then peripherally i.e. the center may shows chronic stage of haemorrhage while the periphery in the subacute stage
Management andTreatment and prognosis
Most haemorrhagic cysts resolve completely within two menstrual cycles.
Cysts with a typical appearance of a haemorrhagic cyst should lead to follow-up ultrasound or MRI imaging if:
- the cyst is > 5 cm in diameter if the patient is pre-menopausalor
- any size of haemorrhagic cyst if the patient is post-menopausal 2
In the late menopausal patient, surgical evaluation is warranted.
Differential diagnosis
Differential considerations on ultrasoundultrasound include:
-
cystic ovarian neoplasm
- the: the most helpful feature in distinguishing hemorrhagic cysts from ovarian neoplasms is the presence of papillary projections and nodular septa in the latter. -
endometrioma:
-- typically contains uniform low level internal echoes with
hypervasularhypervascular wall on Doppler US. On -
on MRI, endometrioma returns high signal in T1 and very low signal in T2 WIs
(shading(shading sign).
- typically contains uniform low level internal echoes with
See also
-<div>-<p><strong>Haemorrhagic ovarian cysts</strong> usually result from haemorrhage into a <a title="Corpus luteum" href="/articles/corpus-luteum">corpus luteum</a> or other <a title="functional ovarian cyst" href="/articles/functional-ovarian-cyst">functional cyst</a>. </p>-<h4>Radiographic features</h4>-<h5>Ultrasound</h5>-<p>They can have a variety of appearances depending on the stage of evolution of the clot. The most typical appearances are that of <strong>lace-like</strong> reticular echoes or an intracystic solid clot. </p>-<p>There should not be any internal blood flow, however circumferential blood flow in the cyst wall is typical. Clot may adhere to cyst wall mimicking a nodule, but has no blood flow on Doppler imaging. </p>-<h5>Pelvic MRI</h5>-<p>Relatively well defined cystic lesion in association with the ovary. Signal characteristics can vary depending on the age of the haemorrhage. In an acute setting</p>-<ul>-<li>-<strong>T1</strong> - high signal</li>-<li>-<strong>T1 C+ (Gd)</strong> - no enhancement</li>-<li>-<strong>T2</strong> - low signal</li>-<li>haemorrhage evolves from the center of the cyst then peripherally i.e. the center may shows chronic stage of haemorrhage while the periphery in the subacute stage</li>- +<p><strong>Haemorrhagic ovarian cysts</strong> (<strong>HOC</strong>) usually result from haemorrhage into a <a href="/articles/corpus-luteum">corpus luteum</a> or other <a href="/articles/functional-ovarian-cyst">functional cyst</a>. Radiographic features are variable depending on the age of the hemorrhage. They typically resolve within eight weeks. </p><h4>Clinical presentation</h4><p>Patients may present with sudden-onset pelvic pain, pelvic mass, or they may be asymptomatic and the HOC is an incidental finding <sup>4</sup>. </p><h4>Pathology</h4><p>HOCs typically develop as a result of ovulation. Secondary to a hormone response the stromal cells surrounding a maturing <a title="Graafian follicle" href="/articles/ovarian-follicle">graafian follicle</a> become more vascular, and after the oocyte has been expelled, the graafian follicle develops into a corpus luteum with a highly vascular and fragile granulosa layer, which ruptures easily forming a HOC <sup>4</sup>. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>HOCs can have a variety of appearances depending on the stage of evolution of the clot. The most typical appearances are that of lace-like reticular echoes or an intracystic solid clot. </p><p>There should not be any internal blood flow, however circumferential blood flow in the cyst wall is typical. Clot may adhere to cyst wall mimicking a nodule, but has no blood flow on Doppler imaging. </p><h5>Pelvic MRI</h5><p>Relatively well defined cystic lesion in association with the ovary. Signal characteristics can vary depending on the age of the haemorrhage. In an acute setting</p><ul>
- +<li>
- +<strong>T1:</strong> high signal</li>
- +<li>
- +<strong>T1 C+ (Gd):</strong> no enhancement</li>
- +<li>
- +<strong>T2:</strong> low signal</li>
- +<li>haemorrhage evolves from the center of the cyst then peripherally i.e. the center may shows chronic stage of haemorrhage while the periphery in the subacute stage</li>
- +</ul><h4>Treatment and prognosis</h4><p>Most haemorrhagic cysts resolve completely within two menstrual cycles.</p><p>Cysts with a typical appearance of a haemorrhagic cyst should lead to follow-up ultrasound or MRI imaging if:</p><ul>
- +<li>the cyst is > 5 cm in diameter if the patient is pre-menopausal<br><em>or</em>
- +</li>
- +<li>any size of haemorrhagic cyst if the patient is post-menopausal <sup>2</sup> </li>
- +</ul><p>In the late menopausal patient, surgical evaluation is warranted.</p><h4>Differential diagnosis</h4><p>Differential considerations on ultrasound<strong> </strong>include:</p><ul>
- +<li>
- +<a href="/articles/cystic-ovarian-neoplasm">cystic ovarian neoplasm</a>: the most helpful feature in distinguishing hemorrhagic cysts from ovarian neoplasms is the presence of papillary projections and nodular septa in the latter</li>
- +<li>
- +<a href="/articles/endometrioma">endometrioma</a>: <ul>
- +<li>typically contains uniform low level internal echoes with hypervascular wall on Doppler US</li>
- +<li>on MRI, endometrioma returns high signal in T1 and very low signal in T2 WIs (<a title="shading sign" href="/articles/shading-sign">shading sign</a>)</li>
-<h4>Management and prognosis</h4>-<p>Most haemorrhagic cysts resolve completely within two menstrual cycles.</p>-<p>Cysts with a typical appearance of a haemorrhagic cyst should lead to follow-up ultrasound or MRI imaging if :</p>-<ul>-<li>the cyst is > 5 cm in diameter if the patient is pre-menopausal or</li>-<li>any size of haemorrhagic cyst if the patient is post-menopausal <sup>2</sup> </li>-</ul>-<p>In the late menopausal patient, surgical evaluation is warranted.</p>-<h4>Differential diagnosis</h4>-<p>Differential considerations on <strong>ultrasound </strong>include:</p>-<ul>-<li>-<a title="cystic ovarian neoplasm" href="/articles/cystic-ovarian-neoplasm">cystic ovarian neoplasm</a> - the most helpful feature in distinguishing hemorrhagic cysts from ovarian neoplasms is the presence of papillary projections and nodular septa in the latter.</li>-<li>-<a title="Endometrioma" href="/articles/endometrioma">endometrioma</a> - typically contains uniform low level internal echoes with hypervasular wall on Doppler US. On MRI, endometrioma returns high signal in T1 and very low signal in T2 WIs (shading sign).</li>-</ul>-<h4>See also</h4>-<ul><li><a title="Haemorrhagic corpus luteal cyst" href="/articles/haemorrhagic-corpus-luteal-cyst">haemorrhagic corpus luteal cyst</a></li></ul>-</div>- +</li>
- +</ul><h4>See also</h4><ul><li><a href="/articles/haemorrhagic-corpus-luteal-cyst">haemorrhagic corpus luteal cyst</a></li></ul>
References changed:
- 4. Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med. 2003;21 (8): 879-86. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12164573">Pubmed citation</a><span class="auto"></span>
Unable to process the form. Check for errors and try again.