Anna Gnida

Case Presentation OB/Gyne

Patient History     

29 year old female Gravida-2, Para-1 LMP: 2 weeks prior H/o of left adnexal mass No complaints of any pain

Lab/Test Results  No previous labs or exams for comparison

Ultrasound Findings  Anteverted uterus appears homogenous with medium level grays measuring 7.5 x 3.9 x 4.6 cm. Small cystic structures seen within the cervix.  Right ovary is unremarkable measuring 3.8 x 2.6 x 1.8 cm.  Left ovary is moderately enlarged measuring 7.9 x 3.6 x 4.0 cm with a large welldefined complex mass with diffuse low level homogenous echoes. Mass measures 6.7 x 3.6 x 3.5 cm & there is no internal flow within.  Normal right & left ovarian flow  A large anechoic region is seen in the posterior cul-de-sac

Anna Gnida

Images

Anna Gnida

Diagnosis  Endometrioma  Few nabothian cysts seen in cervix  Free fluid in the posterior cul-de-sac

Differential Diagnosis  Hemorrhagic cyst  Ovarian abscess

Anna Gnida

Discussion  Endometrioma, also known as a chocolate cyst, is a non-functional cyst caused by endometriosis. An endometrioma is a localized discrete ovarian mass with the echogenicity ranging from cystic to solid, depending on the amount of blood. Low level echoes are present secondary to internal encapsulated bleeding. The size of the mass varies widely from 1cm to more than 10cm in diameter. An endometrioma can be uni or multilocular and patients are usually asymptomatic or have chronic discomfort associated with their menses. Endometriomas may become moderately enlarged and create a surgical emergency by rupturing or by causing the ovary to twist on itself and cause torsion.