Hemoperitoneum following ovarian cyst rupture: CT usefulness in the diagnosis

The rupture of an ovarian cyst is among the most frequent causes of hemoperitoneum in women, and especially in young women. An ultrasound (US) examination performed in emergency allows the easy detection of fluids leaking into the abdomen. It may however be difficult to establish whether this fluid is blood and identify the cyst or the signs of a cystic rupture. The aim of the present study was the assessment of CT diagnostic capabilities in cases of hemoperitoneum following cyst rupture.

CT abdominal studies performed in emergency in 15 patients with surgical findings of ovarian cyst rupture and consequent hemoperitoneum were retro-spectively reviewed. An ultrasound examination carried out in 12 women was positive in all cases for abdominal effusion, without however confirming the presence of an ovarian cyst or without definitely defining the cystic rupture. Spiral CT examinations were performed with a preliminary unenhanced study of the abdomen (10-mm thickness image acquisitions, 10-mm intervals) and with scans obtained after injection of 150 cc of contrast medium (c.m.) at the speed of 2 cc/sec, 60-sec delay; late-phase acquisition scans of the pelvic cavity were obtained in eight of the 15 patients.

CT imaging allowed the depiction of the effusion in all cases. This was limited to the pelvic cavity in five cases and extended to the upper abdomen in the remaining ten patients; in seven of these ten cases, a difference in the density between the upper abdomen and the pelvic cavity was detected. An ovarian cyst was visualized in 11 patients; in eight of them, an irregular opacification of the walls was recorded, suggesting the diagnosis of cystic rupture. In the remaining four cases, a c.m. extravasation was observed, starting from the adnexal region, intracystic in one of them. In all these patients, a hyperdense collection in the pelvic cavity was documented in late-phase acquisitions.

CT imaging in cases of bleeding due to ovarian cyst rupture permits the acquisition of useful diagnostic information: a different effusion density in the pelvic cavity and in the upper abdomen, the direct visualization of the cystic mass (even when involved in a large effusion), the irregularity of opacified cystic walls (a sign of cyst rupture), and finally, the direct extravasion and collection of the c.m. in the pelvic cavity. These is fundamental information in those cases in whom US findings are negative or doubtful.