Here’s a comparison table, Hemorrhagic cyst, Endometrioma, and Malignant ovarian cyst based on US, CT, and MRI:, Key Points to Remember:...

Here’s a comparison table you can use in practice for differentiating Hemorrhagic cyst, Endometrioma, and Malignant ovarian cyst based on US, CT, and MRI:

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🧾 Comparison of Ovarian Cysts

Feature	Hemorrhagic Cyst	Endometrioma	Malignant Cyst
Cause	Bleeding into functional cyst (follicle/corpus luteum)	Ectopic endometrial tissue with cyclic bleeding	Neoplastic (serous, mucinous, germ cell, etc.)
Ultrasound	- Reticular “lace-like” internal echoes (fibrin strands) - No internal vascularity - Posterior acoustic enhancement	- Homogeneous, low-level “ground glass” echoes - Thick wall - No significant vascularity	- Solid components/nodules - Papillary projections - Irregular septations - Internal vascularity on Doppler
CT	- Cystic lesion with hyperdense contents (30–60 HU if blood) - No enhancing solid part	- Homogeneous hyperdense cyst (due to old blood) - “Shading” effect not clear on CT	- Complex cystic-solid mass - Enhancing mural nodules/solid tissue - Ascites, peritoneal deposits possible
MRI	- Blood products: high T1 signal, variable T2 (depending on age of clot) - No enhancement of clot	- High T1 signal (methemoglobin) - T2 shading sign (low T2 signal due to iron/hemosiderin) - Multiple, bilateral possible	- Solid portions enhance with contrast - Irregular septa, papillary projections - Restricted diffusion often present
Clinical Course	Usually resolves spontaneously in 6–8 weeks	Chronic, recurrent, associated with dysmenorrhea/infertility	Progressive, can spread locally/metastasize
Management	Observation + follow-up US Surgery if large/ruptured/torsion	Medical (hormonal therapy) or surgical (laparoscopic excision)	Surgical removal + oncology referral

✅ Key Points to Remember:

• Hemorrhagic cyst: usually transient, re-scan in 6–8 weeks → if resolved → benign.

• Endometrioma: stable, recurrent, with classic “ground glass” US appearance, best seen on MRI with T2 shading.

• Malignant cyst: suspicious if solid enhancing nodules, papillary projections, ascites, peritoneal deposits, or lymphadenopathy.