Spontaneous round ligament hematoma as an unusual cause of pelvic pain in a young female patient: MRI demonstration

Abstract

The cause of pelvic pain remains a significant diagnostic challenge, even for experienced radiologists. An accurate differential diagnosis has to be done according to the patient's age and gender. Spontaneous round ligament hematoma is an uncommon cause of acute pelvic pain in adult female patients. To the best of our knowledge, it has never been reported in the literature in the paediatric population. Ultrasound examination is the first line imaging modality for pelvic pain evaluation in young women but it might result inconclusive. Thanks to its panoramic view and multiparametric approach, the MRI can play a pivotal role in the diagnosis of spontaneous round ligament hematoma in paediatric female patients, resulting in a more effective patient's therapeutic management.

Keywords: MRI; Pediatric pelvic pain; Spontaneous round ligament hematoma.

Fig. 1

Axial T2-weighted TSE (A), axial T1-weighted TSE (B), axial T1-weighted SPIR (C) and coronal T2- weighted TSE (D) scans of the pelvis. The lesion (*) appears partially hyperintense on T1 and T2 weighted scans due to the proteinaceous-haemorrhagic content. Note the right ovary shifted to the left side (arrows).

Fig. 2

Axial high-b value (1000 sec/mm²) DWI- weighted image (A) and corresponding ADC map (B). Note diffusion restriction of the lesion (*) on DWI-weighted image due to the high viscosity of its content. On the ADC map a fluid-fluid level is clearly seen.

Fig. 3

T1 TSE SPIR axial (a) and coronal (c) post-contrast images and corresponding subtracted images. Minimum contrast enhancement of the septa with no macroscopic nodulations are seen within the lesion (*). The right ovary is contralaterally shifted (arrows).