Magnetic resonance imaging features of massive ovarian edema in pregnancy: utility for decisions in expectant management

Abstract

Introduction: Massive ovarian edema (MOE) is a rare disease and few reports have described the magnetic resonance (MR) imaging manifestations in pregnancy.

Case description: We report here a case of MOE in a patient at 12 weeks' gestation. Abdominal T2-weighted MR images showed asymmetric ovarian enlargement in a teardrop configuration, hyperintense peripherally displaced follicles, and twisting of the vascular pedicle between the enlarged ovary and uterus. The diagnosis of MOE due to ovarian torsion was confirmed by exploratory laparotomy. Preoperative imaging, especially the MR imaging could distinguish MOE from other conditions and demonstrate the relations of adjunct organ, and allowed for untwisting during laparotomy with successful preservation of the ovary.

Discussion and evaluation: Ultrasonography is important in detecting, evaluating, and determining the malignant potential of adnexal masses in pregnancy, but its findings may be nonspecific and then MR may assist characterization. This case was tentatively diagnosed as typical MOE by preoperative imaging, but the shape and location of the hugely enlarged ovarian mass suggested torsion of the ovarian pedicle. In our case, the diagnosis was confirmed by exploratory laparotomy and the pedicle was successfully untwisted.

Conclusion: MR imaging proved useful for decisions on expectant management of MOE in pregnancy, and the patient's affected ovary could be preserved.

Keywords: Magnetic resonance imaging; Massive ovarian edema; Pregnancy.

Fig. 1

Transvaginal ultrasonography shows a solid mass (arrow) with hypoechogenic cysts in the Douglas’ pouch

Fig. 2

a Fat-suppressed T2-weighted image shows the markedly high intensity mass (arrow) with peripherally displaced follicles. The ovary has a teardrop configuration and the vascular pedicle appears twisted (arrowhead) beside the enlarged ovary and uterus. b T1-weighted image shows a homogenous low-intensity mass (arrowhead)

Fig. 3

The ovary shows edematous change of the stroma with low cellularity (hematoxylin and eosin, ×100)