Hemorrhagic cyst

Both corpus luteum cysts and endometrioma may show intracystic hemorrhage however, only in endometrioma will a prominent T2 shortening ( shading ) be observed [54]. Furthermore, in endometriosis often multiple hemorrhagic cysts maybe found. 

Fig. 5.6. The color coding of the iodine distribution confirms that the exophytic cortical mass represents a hemorrhagic cyst and not perfused tissue...

Prenatal cocaine exposure has been associated with subependymal hemorrhage and subependymal cyst formation in term neonates and more recently in preterm neonates (<36 weeks of gestation) (325). Medical records and cranial sonograms obtained during 1 year on 122 premature infants showed an increased incidence of subependymal cysts in preterm cocaine-exposed infants (8 of 18) compared with non-exposed infants (8 of 99). There was no increase in the incidence of major structural abnormalities. All subependymal cysts resolved by 4 months of age. The authors noted that the neurodevelop-mental implications of such cyst formation are unknown. 

Complications associated with i.m. administration include nerve injury, muscle contracture, and abscess formation. Less common problems include intramuscular hemorrhage, cellulitis, skin pigmentation, tissue necrosis, muscle atrophy, gangrene, and cyst or scar formation. In addition, injury may occur from broken needles and inadvertent injection into a joint or vein. ... 

Functional cysts may develop internal hemorrhage. Hemorrhagic ovarian cysts typically present with sudden and severe lower abdominal pain. On US, they may appear echogenic or hypoechoic. 

On US hepatic cysts will be seen as multiple anechoic lesions that do not communicate with the liver. Occasionally echogenic debris maybe present inside the cyst, which will correspond to hemorrhage. Renal evaluation by US demonstrating enlarged hyperechogenic kidneys will be obvious prenatally as well as later (Kuhn et al. 2004) (Fig. 4.5e,f). 

Ovaries can be identified on CT and MRI due to their location and soft tissue characteristics. The landmark of the ovaries are follicular structures which can be best identified on T2-weighted MRI [8]. On CT, normal ovaries can be best identified after bowel contrast opacification. They are ovoid soft tissue structures with low attenuation areas which represent normal follicles (Fig. 8.2). Presence of a dominant folhde ranging more than 1 cm in size assists in ovarian identification. Hemorrhagic corpus luteum cysts may he identified by high attenuation values or a fluid-fluid level [9]. 

Corpus luteum cysts have thicker enhancing walls than follicle cysts following intravenous contrast application (Fig. 8.6). Corpus luteum cysts may contain blood with bright signal on Tl and T2 as a sign of subacute hemorrhage [8]. Resolution is expected in on follow-up after two to three menstrual cycles and proves the diagnosis of a functional cyst. 

The majority of ovarian cysts are foUicular cysts resulting from failure of rupture or of regression of the Graalian follicle. Under nonpregnant conditions, corpus luteum cysts derive fi om failure of regression or hemorrhage into the corpus luteum. 

Functional cysts are asymptomatic in the majority of cases. Progesterone production may persist in corpus luteum cysts, resulting in delayed menstruation or bleeding anomahes. Large physiologic cysts may cause abdominal pressure or low back pain. Acute abdomen is caused by comphcations such as rupture, hemorrhage, or torsion. 

Endometrioid carcinomas represent 8% of all ovarian carcinomas. They occur with synchronous endometrial carcinomas or endometrial hyperplasia in up to 33% of cases [39]. Furthermore, an association with breast cancer has been reported [2]. Rarely, endometrioid carcinoma may arise from endometriosis [40]. Bilateral ovarian involvement is encountered in 30%-50% of cases. Macroscopically, these tumors are solid and cystic, the cysts may contain mucinous or greenish fluid. Rarely, solid tumors with extensive hemorrhage or necrosis may be found [2]. 

Clinically, ruptured ovarian cysts may resemble ovarian torsion. In a patient with acute pelvic pain, a hemorrhagic lesion within a normal size ovary is typically a ruptured ovarian cyst. Furthermore, unlike in most cases of ovarian torsion, clotted blood may be detected in the lesser pelvis. Wall edema of an adnexal mass, engorged adnexal vessels or dilatation of the fallopian tube are missing. TUboovarian abscess and hydrosalpinx may resemble advanced adnexal torsion. Lack of enhancement supports the diagnosis of ovarian torsion. In children, sonography usually allows the diagnosis of appendicitis as a cause of acute pelvic pain. In case of a suspected abscess or an ovarian mass, MRI may aid in further assessment of the adnexa. Rarely, a calcified mass may result from chronic infarction which cannot reliably be differentiated from a calcified ovarian tumor [19]. 

Fig. 17.8. Torsion of a normal ovary. Transaxial T2WI at umbilical level. In a 14-year-old girl with excessive intermittent pelvic pain for several days, sonography detected an indeterminate solid right adnexal mass. MRI shows a predominantly low-signal-intensity mass with numerous small peripheral cysts (small arrows), representing displaced follicles. Normal left ovary( ) At surgery, the right ovary had undergone complete hemorrhagic infarction. Courtesy of Dr. K. Kinkel, Geneva...

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