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Clinical Image: An abnormal ovary

An abnormal ovary

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 31 year-old woman consulted the gynecologic outpatient clinic complaining of dysmenorrhea, dyspareunia and daily abdominal discomfort since several months. The pain is progressive since ceasing the oral contraceptive pill in order to conceive.  She has a regular cycle, with an average duration of 28 days and a menstruation lasting 3-4 days.

Vaginal examination showed a normal cervix, the uterus was reduced mobile. Transvaginal ultrasound showed on different occasion, the same variable echogenic anomaly.

Transvaginal ultrasound

Question about the transvaginal ultrasound.

A. Schreurs & J. Bramer

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Endometrioma, because combined with clinical complaints of endomtriosis it is most likely that this cyst is an endometrioma.

Why the other answers are not correct:

  • Persistent follicle, a follicle should differ in size over time and disappear.
  • Corpus luteum, this should differ in size over time and disappear, but it could look a lot like it. That is why it is important to follow cysts over time.
  • Pregnancy of unknown location –> There will not be a menstruation during pregnancy, so complaints of recurrent dysmenorrhea does not fit with a P.U.L.. A P.U.L. could be an acute and severe problem with heavy abdominal pain that should be investigated immediately.

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