Imaging description

Massive ovarian edema is a rare and poorly understood condition characterized by marked unilateral (rarely bilateral) ovarian enlargement due to gross diffuse stromal edema [1]. It likely represents chronic or subacute vascular or lymphatic congestion related to incomplete torsion or other obstructive pathophysiology [2–4]. The condition is usually detected at pelvic ultrasound, where it manifests as asymmetric ovarian enlargement with echogenic stroma and peripherally displaced follicles (Figure 77.1). At MRI (Figures 77.1–77.3), the ovarian stroma characteristically demonstrates marked T2 signal hyperintensity and may demonstrate increased T1 signal intensity (possibly reflecting hemorrhage). The ovary may have a teardrop configuration [2]. The teardrop configuration supports the concept that massive ovarian edema reflects chronic vascular congestion of the ovary, with the ovarian pedicle being either torsed or compressed.

Importance

The optimal management of massive ovarian edema is unknown, because most cases have undergone surgery based on a preoperative assumption that the ovarian enlargement was due to tumor. Less aggressive surgical management for massive ovarian edema includes deep wedge resection for definitive diagnosis and detorsion or fixation [1, 5–7].

Typical clinical scenario

Massive ovarian edema may occur at any age, with a mean age at diagnosis of 20 years [5]. Presenting features include recurrent intermittent abdominal pain or distension, palpable pelvic mass, menstrual irregularity, or hormonal effects such as early puberty or virilization [6, 7]. Massive ovarian edema may occasionally complicate pregnancy [2].