History: 37 yo female with acute onset abdominal pain, light-headedness and bloating.
Solution: Endometriosis
The findings in this case are obvious. Bilateral adnexal masses with copious amounts of intra-abdominal fluid. The first thing that comes to mind in this setting is ovarian carcinoma. However, if you consider the age of the patient, the acute nature of the symptoms and the associated light-headedness, then you should also consider processes that result in intra-abdominal hemorrhage, such as ectopic pregnancy, or as in this case endometriosis.
Endometriosis is the deposition of endometrial tissue in an ectopic site outside of the uterus and is a common gynecological problem affecting 5-10% of menstruating women. It has variable clinical penetrance and symptoms, but these can include cyclical pelvic pain, constant pelvic pain, infertility, and uncommonly anemia or intraperitoneal hemorrhage.
The process can be diffuse with \"gun powder\" spots studding the peritoneum, or can be a mass-like process (i.e. endometrioma). Classic endometriomas are described as \"chocolate cysts\" i.e. homogeneous low-level internal echoes within an adnexal cyst. MR can be specific as well with identification of \"T2 shading\" and homogeneous hyperintensity on T1, but the appearance can be somewhat variable.
Treatment in this case was surgical because of the emergent nature of the patient\'s presentation, but the symptoms can often be controlled with hormonal therapy.
The findings in this case are obvious. Bilateral adnexal masses with copious amounts of intra-abdominal fluid. The first thing that comes to mind in this setting is ovarian carcinoma. However, if you consider the age of the patient, the acute nature of the symptoms and the associated light-headedness, then you should also consider processes that result in intra-abdominal hemorrhage, such as ectopic pregnancy, or as in this case endometriosis.
Endometriosis is the deposition of endometrial tissue in an ectopic site outside of the uterus and is a common gynecological problem affecting 5-10% of menstruating women. It has variable clinical penetrance and symptoms, but these can include cyclical pelvic pain, constant pelvic pain, infertility, and uncommonly anemia or intraperitoneal hemorrhage.
The process can be diffuse with \"gun powder\" spots studding the peritoneum, or can be a mass-like process (i.e. endometrioma). Classic endometriomas are described as \"chocolate cysts\" i.e. homogeneous low-level internal echoes within an adnexal cyst. MR can be specific as well with identification of \"T2 shading\" and homogeneous hyperintensity on T1, but the appearance can be somewhat variable.
Treatment in this case was surgical because of the emergent nature of the patient\'s presentation, but the symptoms can often be controlled with hormonal therapy.
CT Images
