Sonographic Findings of Ovarian Hemorrhage Presenting Acute Abdomen

Abstract

PURPOSE: To obtain the characteristic sonographic findings of ovarian hemorrhage and investigate the usefulness of ultrasonography in the diagnosis. MATERIALS AND METHODS: Forty-nine cases presenting acute abdomen diagnosed as ovarian hemorrhage by ultra-sonography or surgicopathological confirmation. We observed the size and margin of the ovary, size, pattern, shape, wall and internal echogenecity of the masses and the amount of hemoperitoneum. We also performed a color Doppler study to evaluate the blood flow pattern and resisitive index(RI). RESULTS: The age of patients were between 21~41. Most symptoms occurred from days 14 to 30 of her menstrual cycle and were presented for less than 24 hours. Twenty patients had a history of intercourse shortly before the onset of the symptom. Thirty two cases involved the right ovary while the other 17 cases involved the left. All patients had a negative urine or serum hCG test except for 4 pregnant women. The size of the ovary was mea-sured as mean 5.1 cm and marginal irregularity was noted in 36 cases. Mixed echoic solid masses were observed in 6 cases and variable echogenecity of cystic masses were seen in 43 cases. Maximal diameter of adnexal mass-es were measured as mean 3.95 cm. Internal echogenecity of cystic masses appeared as mainly heteroge-neous(21). Twenty two cystic masses had a thick irregular wall and 17 had a thin smooth wall. Hypoechoic rim-like halo surrounding was noted in 17 cystic masses. 17 cases seemed to have a small amount of hemoperi-toneum, a moderate amount in 22 cases. and a large amount in 9 cases. The blood flow pattern of cystic masses showed a rim(29) and spotty(8) pattern in the color Doppler study. Measured RI was 0.41(mean). CONCLUSION: Fertile women with the complaint of acute abdominal pain, who has the laboratory data of negative hCG test, ultrasonographic findings of enlargement of ovary with irregular margin, heterogeneous echoic cystic mass, peripheral halo surrounding the mass, hemoperitoneum and low resistance index of peripheral blood flow of the mass may be useful for the diagnosis of ovarian hemorrhage and differentiating it from other causes pre-senting acute abdomen.