Ruptured endometrioma: main imaging findings

<!-- Brazil - Ruptured endometrioma: main imaging findings Ruptured endometrioma: main imaging findings window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-MKLVK7B5B6'); .articleTxt{ top: -16px; } .scielo__border-top{ border-top: 1px solid #ccc !important; } @media (max-width: 575.98px) { .articleCtt > .container{ padding-left: 0; padding-right: 0; } .articleCtt .articleTxt{ padding-left: 16px !important; padding-right: 16px !important; } } @media (min-width: 768px){ .scielo__truncate{ display: block; max-width: 285px; } } Menu Brazil Journal list by title Journal list by subject area Search Metrics (abre em nova aba) Sobre o SciELO Brazil Contacts Report error SciELO.org - The SciELO Network (abre em nova aba) National and thematic collections (abre em nova aba) Journal list by title (abre em nova aba) Journal list by subject (abre em nova aba) Search (abre em nova aba) Metrics (abre em nova aba) OAI and RSS (abre em nova aba) About the SciELO Network (abre em nova aba) Contacts (abre em nova aba) Blog SciELO in Perspective (abre em nova aba) (function () { const details = document.getElementById('scieloMainMenu'); if (!details) return; const summary = document.getElementById('scieloMainMenuSummary'); if (!summary) return; document.addEventListener('click', function (event) { if (!details.contains(event.target) && details.open) { details.open = false; } }); document.addEventListener('keydown', function (event) { if (event.key === 'Escape' && details.open) { details.open = false; summary.focus(); } }); })(); Brazil language en English Português Español Radiologia Brasileira Mostrar opções launch Submission of manuscripts info About the journal help_outline Política editorial people Editorial Board help_outline Instructions to authors email Contact show_chart Metrics home Table of contents navigate_before previous current next navigate_next Text (EN) Text (English) Text (Portuguese) PDF Download PDF (English) Download PDF (Portuguese) article Conteúdo: Text (EN) Text (English) Text (Portuguese) Download PDF (English) (abre em nova aba) Download PDF (Portuguese) (abre em nova aba) share Whatsapp BlueSky Mastodon Facebook Mais home Table of contents share Whatsapp BlueSky Mastodon Facebook Mais Text (EN) Text (English) Text (Portuguese) PDF Download PDF (English) (abre em nova aba) Download PDF (Portuguese) (abre em nova aba) Letters to the Editor • Radiol Bras 51 (6) • Nov-Dec 2018 • https://doi.org/10.1590/0100-3984.2017.0092 link copy Ruptured endometrioma: main imaging findings Authorship SCIMAGO INSTITUTIONS RANKINGS Dear Editor, A 28-year-old woman presented with a 12-h history of acute pelvic pain. Physical examination revealed signs of peritonitis, and laboratory tests showed mild anemia. The patient underwent transvaginal ultrasound (TVUS) of the pelvis ( Figure 1A ) and magnetic resonance imaging (MRI) of the pelvis ( Figures 1B and 1C ). She also underwent laparoscopy, which confirmed the presence of bilateral ovarian endometriosis, with a rupture on the right side ( Figure 1D ). Figure 1 TVUS showing a cyst with irregular contours and hypoechoic content in the right ovary. B,C: MRI of the pelvis showing formations with high signal intensity in T1-weighted images ( B ) and low signal intensity in T2-weighted images (“shading” in C , arrow) in both ovaries, with irregular contours in the right ovary. Fluid content in the pelvic cavity with high signal intensity on the T1-weighted image ( B ), indicating hemoperitoneum. This set of findings is suggestive of bilateral endometriomas, with signs of rupture of the right endometrioma. D: Image obtained in laparoscopic access of the pelvic cavity showing active bleeding (arrow) in the right ovary and blood content collected in the pelvic recess (star), findings that correspond to those seen on TVUS and MRI. The presumptive diagnosis of endometriosis is based on a clinical history consistent with the diagnosis and abnormal laboratory tests, including elevation of CA-125, a marker that, although nonspecific, is usually elevated in women with the disease ( 1 ) . Despite the important role of imaging examinations, notably TVUS and MRI of the pelvis in the diagnosis and staging of endometriosis, it should be noted that the gold standard for the definitive diagnosis is still laparoscopy ( 1 , 2 ) . The ovaries are among the sites most commonly affected by endometriosis (in 20-40% of cases). Endometriomas are thick-walled cysts containing dark, thick degenerated blood products. In some cases, there can be a fluid-fluid level, representing bleeding of various chronologies, giving them the typical macroscopic appearance of “chocolate cysts”, which can be transposed to imaging exams ( 3 ) . They are bilateral in approximately 50% of cases ( 2 , 4 ) . The rupture of an endometrioma is a rare event, with an estimated incidence of less than 3% among women of childbearing age who are known to have endometriomas ( 5 ) . This situation occurs more commonly during pregnancy, due to hormonal stimulation of endometrial stromal elements ( 2 ) , albeit with larger (≥ 6.0 cm) lesions ( 6 ) . The imaging aspect of endometrioma is that of an ovarian cyst with heterogeneous content, irregular contours, and parietal discontinuity, together with hemoperitoneum, which can be seen as heterogeneous fluid content on ultrasound and as a collection with a hyperintense signal in T1-weighted MRI sequences. In an emergency setting, its presentation may mimic other acute gynecological conditions, such as corpus luteum, ectopic gestation, and even spontaneous hemoperitoneum ( 7 , 8 ) . In addition, the rupture of endometriomas can significantly increase serum CA-125 levels, mimicking ovarian epithelial neoplasms ( 9 ) . However, a history of endometrioma, previous examinations demonstrating endometriomas, or endometriomas accompanied by peritoneal blood content in emergency imaging studies should raise the suspicion of spontaneous rupture. The importance of the preoperative diagnosis is to support treatment strategies. Although some milder cases can be managed conservatively, there is a tendency toward greater use of early surgical exploration because of long-term undesirable effects of cyst fluid in the peritoneal cavity, such as adhesions, pelvic pain, and infertility ( 6 ) . In addition, the presumptive diagnosis of ruptured endometrioma, rather than ovarian neoplasms, facilitates the decision to perform laparoscopic exploration and allows the surgeon to perform the procedure with greater confidence. REFERENCES 1 Siegelman ES, Oliver ER. MR imaging of endometriosis: ten imaging pearls. Radiographics. 2012;32:1675-91. 2 Chamié LP, Blasbalg R, Pereira RM, et al. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics. 2011;31:E77-100. 3 Bastos BB, Fonseca EKUN, Yamauchi FI, et al. Chocolate cyst with ground glass appearance in endometriomas. Abdom Radiol (NY). 2017;42:2957-8. 4 Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: diagnosis with MR imaging. Radiology. 1991;180:73-8. 5 Evangelinakis N, Grammatikakis I, Salamalekis G, et al. Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study. Clin Exp Obstet Gynecol. 2009;36:254-5. 6 Huang YH, Hsieh CL, Shiau CS, et al. Suitable timing of surgical intervention for ruptured ovarian endometrioma. Taiwan J Obstet Gynecol. 2014;53:220-3. 7 Lucey BC, Varghese JC, Anderson SW, et al. Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol. 2007;14:65-75. 8 Brown DL, Dudiak KM, Laing FC, et al. Adnexal masses: US characterization and reporting. Radiology: 2010;254:342-54. 9 Rani AK, Kapoor D. Ruptured ovarian endometrioma with an extreme rise in serum CA 125 level - a case report: ovarian endometrioma with very high CA-125 level. Gynecol Oncol Case Rep. 2012;2:100-1. Publication Dates Publication in this collection Nov-Dec 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Authorship .author-card { border-bottom: 1px solid #ccc; padding: 1rem 0; } .author-card:last-child { border-bottom: 0px; } .author-name { font-weight: 600; } .orcid-button { padding-left: 2.5rem; } .modal-body { padding-bottom: 3rem; } .orcid-button::before { content: ""; position: absolute; background-image: url(https://ds.scielo.org/img/logo-orcid.svg); background-repeat: no-repeat; background-size: 1.5em auto; background-position: .5em center; display: block; width: 60px; height: 60px; top: -10px; left: 0; } person Eduardo Kaiser U. N. Fonseca school Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Hospital Israelita Albert Einstein Brazil São Paulo, SP, Brazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 0000-0002-0233-0041 person Bruna Bringel Bastos school Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Hospital Israelita Albert Einstein Brazil São Paulo, SP, Brazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 0000-0001-9875-8458 person Fernando Ide Yamauchi school Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Hospital Israelita Albert Einstein Brazil São Paulo, SP, Brazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 0000-0002-4633-3711 person Ronaldo Hueb Baroni school Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Hospital Israelita Albert Einstein Brazil São Paulo, SP, Brazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 0000-0001-8762-0875 Correspondence: Dr. Fernando Ide Yamauchi. Hospital Israelita Albert Einstein - Departamento de Imagem. Avenida Albert Einstein, 627, Jardim Leonor. São Paulo, SP, Brazil, 05652-900. E-mail: [email protected] . SCIMAGO INSTITUTIONS RANKINGS Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Hospital Israelita Albert Einstein Brazil São Paulo, SP, Brazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Figures Figures (1) Thumbnail Figure 1 TVUS showing a cyst with irregular contours and hypoechoic content in the right ovary. B,C: MRI of the pelvis showing formations with high signal intensity in T1-weighted images ( B ) and low signal intensity in T2-weighted images (“shading” in C , arrow) in both ovaries, with irregular contours in the right ovary. Fluid content in the pelvic cavity with high signal intensity on the T1-weighted image ( B ), indicating hemoperitoneum. This set of findings is suggestive of bilateral endometriomas, with signs of rupture of the right endometrioma. D: Image obtained in laparoscopic access of the pelvic cavity showing active bleeding (arrow) in the right ovary and blood content collected in the pelvic recess (star), findings that correspond to those seen on TVUS and MRI. image Figure 1 TVUS showing a cyst with irregular contours and hypoechoic content in the right ovary. B,C: MRI of the pelvis showing formations with high signal intensity in T1-weighted images ( B ) and low signal intensity in T2-weighted images (“shading” in C , arrow) in both ovaries, with irregular contours in the right ovary. Fluid content in the pelvic cavity with high signal intensity on the T1-weighted image ( B ), indicating hemoperitoneum. This set of findings is suggestive of bilateral endometriomas, with signs of rupture of the right endometrioma. D: Image obtained in laparoscopic access of the pelvic cavity showing active bleeding (arrow) in the right ovary and blood content collected in the pelvic recess (star), findings that correspond to those seen on TVUS and MRI. open_in_new How to cite link copy function currentDate() { var today = new Date(); var months = ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] today.setTime(today.getTime()); return today.getDate() + " " + months[today.getMonth()] + " " + today.getFullYear(); } var citation = 'Fonseca, Eduardo Kaiser U. N. et al. Ruptured endometrioma: main imaging findings. Radiologia Brasileira [online]. 2018, v. 51, n. 6 [Accessed CURRENTDATE], pp. 411-412. Available from: . ISSN 1678-7099. https://doi.org/10.1590/0100-3984.2017.0092.'.replace('CURRENTDATE', currentDate()); document.getElementById('citation').innerHTML = citation; document.getElementById('citationCut').value = citation.replace('<', ' "); more_horiz Ferramentas do artigo file_download PDFs show_chart Metrics image Figuras e tabelas translate Versions and translations link How to cite this article article Related articles location_on Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil E-mail: [email protected] rss_feed Stay informed of issues for this journal through your RSS reader PDF version for download PDF English Portuguese Related articles Lista de links para artigos relacionados. Os links abrem em nova aba. Google (abre em nova aba) Google Scholar (abre em nova aba) Versões e tradução automática Escolha a versão original do texto ou utilize um serviço de tradução automática. Versão original do texto English Português Tradução automática Google Translator (abre serviço externo de tradução) Microsoft Translator (abre serviço externo de tradução) pre { display: block; padding: 9.5px; margin: 0 0 10px; font-size: 11px; line-height: 1; word-break: break-all; word-wrap: break-word; background-color: #f5f5f5; border: 1px solid #ccc; border-radius: 4px; white-space: pre-wrap; word-break: break-word; } Como citar Escolha um formato para exportar ou selecione um estilo de citação. O conteúdo abaixo pode ser atualizado após a seleção. Baixar em RIS Baixar em BIBTEX Outros formatos de citação e exportação: Enter references manager format or citation style (e.g., "APA", "AMA", "MLA", "Vancouver") vertical_align_top Go to top // Mostrar o botão ao rolar const btnTop = document.getElementById("btnTop"); window.addEventListener("scroll", () => { if (window.scrollY > 200) { btnTop.style.display = "block"; } else { btnTop.style.display = "none"; } }); // Rolar suavemente até o topo ao clicar btnTop.addEventListener("click", () => { window.scrollTo({ top: 0, behavior: "smooth" }); }); .scielo__logo-partner{ max-height: 50px; max-width: 170px; } .scielo__logo-partner--dark{ display:none; } .scielo__theme--dark .scielo__logo-partner--light{ display:none; } .scielo__theme--dark .scielo__logo-partner--dark{ display:inline-block; } Brazil Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil E-mail: [email protected] Read our Open Access Statement Metrics SciELO Analytics Dimensions Altmetric Scite_ Ruptured endometrioma: main imaging findings PlumX × Close Message × Close Message Report error // Variáveis para tradução da barra de acessibilidade window.accessibilityTranslations = { darkMode: "Dark mode", increaseText: "Increase text", decreaseText: "Decrease text", originalText: "Original text", markerLine: "Marker", readingLine: "Guide line", reset: "Reset", accessibilityMenu: "Accessibility menu", skipLinkText: "Ir para o conteúdo principal" }; $(document).ready(function() { // Add rows article search let addRowBtn = $('.addRowBtn'); let placeRow = $('.scielo__dinamic-row'); let newFormRow = ' clear AND OR AND NOT All indexes Year Author Funder Journal Abstract Title '; let btnRemoveRow = $('.btn-danger'); addRowBtn.on( "click", function() { placeRow.append( newFormRow ); }) // Remove as linhas inseridas dinamicamente e as que já estavam lá. placeRow.on( "click", ".btn-danger", function() { $(this).parent().parent().animate({'opacity':0},300).hide(1); }) }); <!-- var insertScript = function(url, callback, parentNode) { var scriptNode = document.createElement("script"); scriptNode.src = url; scriptNode.onload = callback; parentNode.appendChild(scriptNode) } var headNode = document.getElementsByTagName("head")[0]; setTimeout(MathJax.Callback([insertScript, "//badge.dimensions.ai/badge.js", console.log, headNode]), 1500); --> affiliations = {}; function add_scimago_image(selector, remove_br=true, add_br_after=true, find_div=false){ $(selector).each( function () { if (remove_br){ $(this).find("br").remove() } internal_items = find_div ? $(this).find('div').not(".clearfix") : $(this).not(".clearfix") internal_items.each(function () { self = $(this); affiliation_name = $('span:first', self).text(); if (affiliation_name){ scimago_link = ' '; self.append(scimago_link); } }); if (add_br_after){ $(this).after(" ") } }); } add_scimago_image('#ModalScimago .info div') add_scimago_image('.tutors', remove_br=false, add_br_after=false, find_div=true) $(".scimago_link").click(function(e){ e.preventDefault(); affiliation_name = $(this).data("affiliation"); if (affiliation_name){ if (affiliations[affiliation_name]) { window.open(affiliations[affiliation_name], '_blank'); } else { $.ajax({ type: "GET", async: false, url: "/scimago/query", data: 'q=' + encodeURI(affiliation_name), success: function (data) { if (data) { affiliations[affiliation_name] = 'https://www.scimagoir.com/' + data window.open(affiliations[affiliation_name], '_blank'); }else{ toastr.options = { positionClass: 'toast-top-center' }; toastr.error('Link temporariamente indisponível'); } } }); } } }); var howcite_initialized = false; $('#ModalHowcite').on('shown.bs.modal', function () { if (!howcite_initialized) { initial = { "American Psychological Association": "apa", "Vancouver": "vancouver" } $.each(initial, function (key, value) { $.ajax({ url: "/citation/WSgrvDPQbHg7JFmszXHHXPr/?style=" + value, dataType: 'html', delay: 250, async: true }) .done(function (html) { $(" " + key + " " + " " + html + " ").insertBefore($("#select_label")); }) }); howcite_initialized = true; } $(".js-data-example-ajax").select2({ ajax: { url: "/citation/list", dataType: 'json', delay: 250, data: function (params) { return { q: params.term, // search term }; }, processResults: function (data, params) { return { results: data.results }; }, cache: true }, escapeMarkup: function (markup) { return markup; }, minimumInputLength: 1, dropdownParent: $('#ModalHowcite') }); $(document).on('select2:open', () => { document.querySelector('.select2-search__field').focus(); }); $(".js-data-example-ajax").on('select2:select', function (e) { var data = e.params.data; $.ajax({ url: "/citation/WSgrvDPQbHg7JFmszXHHXPr/?style=" + data.id, dataType: 'html', delay: 250 }) .done(function (html) { if ($('#citation_text').css('display') == 'none') { $('#citation_text').show() } $("#citation_text").html(html); }) .fail(function () { alert("Erro ao tentar obter esse estilo de citação"); }) }); }); // Garante que o valor do campo share_url é a URL corrente. $('#share_url').val(window.location.href); //moment.locale('en'); //$("#date").text(moment().format("L HH:mm:ss ZZ"));