Clinical Review
![](https://cdn-uat.mdedge.com/files/s3fs-public/styles/max_width_small/public/Image/September-2017/OBGM02508_h9_01.jpg)
What is causing her abdominal pain?
How transvaginal ultrasound can expedite the diagnosis
Michelle L. Stalnaker, MD, and Andrew M. Kaunitz, MD
Interpretation of 12 stunning images, including color Doppler, demonstrating tell-tale signs of, as well as findings not to be confused with, this entity
FOREWARD
Steven R. Goldstein, MD, CCD, NCMP
Professor, Department of Obstetrics and Gynecology, New York University School of Medicine; Director, Gynecologic Ultrasound; and Co-Director, Bone Densitometry, New York University Medical Center, New York
This is the inaugural offering in a new series, titled Images in Gyn Ultrasound. It is interesting and important that Dr. Michelle Stalnaker and Dr. Andrew Kaunitz have chosen hemorrhagic ovarian cysts as their debut topic.
Realize that since the vaginal probe was introduced in the 1980s, our entire specialty has had to undergo a learning curve--just as individuals will have a learning curve. In the early days of transvaginal ultrasound, an imager often provided a differential for such masses, along the lines of “compatible with hemorrhagic cyst, endometrioma, dermoid…cannot rule out neoplasia.” Today, however, with better understanding, and especially with the addition of color flow Doppler, very often a definitive diagnosis can be made.
These “hemorrhagic cysts” are nothing more than bleeding into a corpus luteum at the time of ovulation−the more blood that collects before tamponade or clot stops its accumulation, the larger the “cyst” can become. As the cyst goes through a “maturation” process and undergoes clot retraction and clot lysis, the variable internal echo patterns presented in the following images are possible, but there will ALWAYS only be peripheral blood flow as evidenced by the morphologic appearance of the vascular distribution. See video.
Study these images carefully as they are very representative of the many faces of the hemorrhagic corpus luteum.
Hemorrhagic ovarian cysts: One entity with many appearances
Michelle L. Stalnaker, MD
Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville
Andrew M. Kaunitz, MD
University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz is a member of the OBG Management Board of Editors.
Hemorrhagic cysts are normal in ovulatory women, usually resolving within 8 weeks. They can be quite variable in appearance, however, and can be confused with ovarian endometriomae. Presenting characteristics can include:
Management. With respect to hemorrhagic cysts, the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement indicates:
How transvaginal ultrasound can expedite the diagnosis
Steven R. Goldstein, MD, presents 3 videos demonstrating ultrasound examination of a hemorrhagic cyst: 1. Transvaginal ultrasound of a corpus...
MRI shouldn’t be the first-line modality for characterizing a mass. Rather, make it your effective problem-solver when ultrasonography has left...
The tubes shed some of their mystery during interrogation by ultrasonography, which can highlight abnormalities such as inflammation, infection,...
Not all neoplasms represent cancer, and some have overlapping sonographic characteristics. Here’s what you need to know to differentiate what is...