35-year-old patient with pelvic pain



Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian


Case Section

Genital Female Imaging


Patient's Information

Gender : Female
Age : 35


Clinical Summary

35-year-old patient with pelvic pain


Imaging Findings

Three cystic lesions in right ovary are seen.One of them contains fluid which are high on T2- and low on T1-weighted images and surrounds by a thin enhancing wall,most compatible with simple ovarian cyst.The another ones demonstrate homogeneously high signal intensity on T1-weighted images with various gradations of decrease signal on T2-weighted sequences indicative of endometriomas.The two later lesions are surrounded by a fibrous wall,dark on T1- and T2-weighted sequences without obvious enhancement.


Differential Diagnosis



Final Diagnosis

Ovarian endometriomas


Discussion (Related Text)

The hallmarks of endometriosis are endometriomas, endometrial implants, and adhesions, all of which demonstrate distinctive features at MR imaging. Endometriosis involves the ovaries more frequently than it does extraovarian sites. Endometriomas, also known as “chocolate cysts,” are ovarian cysts with a fibrous wall lined by functioning endometrial tissue and high concentrations of blood breakdown products accumulated over successive menstrual cycles. Uncomplicated endometriomas generally have an enhancing wall of variable thickness. A highly sensitive MR feature of endometriomas is their homogeneous lightbulb-like brightness on T1-weighted fat-suppressed images, which is attributed to the high concentration of paramagnetic hemoglobin in blood breakdown products. “T2 shading,” a feature that ranges from a homogeneous signal void through various gradations of decreased signal intensity seen at T2-weighted imaging in lesions that show signal hyperintensity at T1-weighted imaging, improves the specificity of MR imaging for the characterization of lesions as endometriomas.



RadioGraphics 2012; 32:845–86


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