A TALE OF TWO CYSTS: HEMORRHAGIC VS ENDOMETRIOTIC CYST

HEMORRHAGIC VS ENDOMETRIOTIC CYST

     T2 W  TRA                                           T1 W FS TRA                             T2 W SAG

                                     DWI                                          ADC

 Clinical History:

 51 / F

Previous Hysterectomy and cystectomy for chocolate cyst. Ovaries retained

Findings:

1. Cyst marked with (*)  is a hemorrhagic cyst: 

T2W hypointense and shows fluid level (in the sagittal image). It is not showing hyperintense signal on T1 W FS images and does not show restricted diffusion. This suggests acute hemorrhage (Deoxyhemoglobin)

2. Cyst marked with (red arrow) is an endometriotic cyst: 

Mixed intensity on T2W image (shading) and shows hyperintense signal on T1 W FS. It also shows restricted diffusion. This suggests sub-acute hemorrhage (methemoglobin). Peripheral hypointensity in the cyst on the T2W images represent hemosiderin.