Corpus luteal cyst rupture

Ruptured corpus luteal cysts are one of the commonest causes of spontaneous hemoperitoneum in a woman of reproductive age.

Clinical presentation

Presentation is variable, ranging from completely asymptomatic to severe abdominal pain due to peritoneal irritation.


The corpus luteum is a thick-walled cystic structure that is prone to internal hemorrhage, and sometimes peritoneal rupture.

Radiographic features

  • complex adnexal cyst
  • rim of increased echogenicity surrounding a cystic component
  • free fluid with areas of increased echogenicity representing hemoperitoneum
  • on Doppler, peripheral vascularity may be seen ("ring of fire sign") 
  • at times the entire rupture and hemorrhage form an organized hematoma and a complex vascular adnexal mass
  • well circumscribed cystic lesion
  • thick walled cyst (<3 mm) with inhomogeneous contrast enhancement
  • high attenuation component (45-100 HU)
  • “fluid-fluid hematocrit” level
  • hemoperitoneum with free fluid near the source of bleeding can have high attenuation value (60-65 HU), “sentinel clot” and the attenuation of free fluid reduces further from the source

Differential diagnosis

Possible considerations include: