Endometriosis - hematosalpinx and kissing ovaries

Case contributed by Dr Bahman Rasuli

Presentation

Severe chronic pelvic pain and dysmenorrhea and abnormal uterine bleeding.

Patient Data

Age: 40 years
Gender: Female

The uterus is mildly enlarged measuring about 60 x 75 x 115 mm and shows heterogeneous parenchyma signal intensity.

Both ovaries appear enlarged and in close proximity, containing irregular cystic lesions of variable sizes.

There are two large abnormal signal cystic lesions at the left adnexa measuring about 90 x 105 x 135 mm and 40 x 50 x 55 mm containing blood products of high signal intensity on T1/T2 compatible with endometrioma cysts.

Another similar high signal ( high on T1/T2 ) cystic lesion measuring about 20 x 30 x 45 mm at the right adnexa is compatible with an endometrioma cyst.

Two fluid equivalent signal follicular cysts with maximum diameters up to 24 mm and 28 mm are seen at the right adnexa due to follicular cysts.

Bilateral fallopian tubes are dilated with the tortuous course and internal high signal content ( high on T1/T2 ) suggestive of tubal blood, which is more pronounced on the left side, in keeping with bilateral hematosalpinx.

Case Discussion

MRI appearances of bilateral ovarian endometriomas and hematosalpinx (larger on the left).

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