Presentation
Abdominal pain.
Patient Data
Large volume intermediate density fluid filling the abdomen and pelvis, measuring about 35 Hounsfield units, with large left hemorrhagic cyst with fluid/fluid level and surrounding hematoma, with a small jet of active bleeding along the inferior margin (note disbursement on portal venous phase when compared to arterial phase). Enlarged heart with findings related to mitral stenosis and valve replacement in the setting of rheumatic heart disease.
Case Discussion
Teaching case of a large hemorrhagic ovarian cyst complicated by active bleeding and large volume hemoperitoneum. The biphasic protocol used in this example was helpful for identifying the site of active bleeding along the inferior margin, although even with a single-phase examination this amount of blood is concerning for substantial ongoing bleeding and would require surgical attention.
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