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Daniel Mauricio Alvarez, Eranga Perera, Shweta Bhatt and Vikram S Dogra,MD.
Research assistant to Dr. Dogra
University of Rochester & Tecnologico de Monterrey

Figure Legends : 


1(a,b). US longitudinal and transverse scans show a 13 cm right adnexal lesion, that has  multiple simple cysts in the ovarian stroma.

2. Doppler color image demonstrates vascularity in the ovarian stroma.

3. Longitudinal US scan shows placenta (arrow) and partial fetal skull  (blue arrow) and the multicystic lesion in the right adnexa (arrowhead)

4.Longitudinal US scan  of the right lower quadrant demonstrates  the relationship between the  right theca lutein cyst (arrow) the right kidney and the liver.

Case Description

Clinical History: 


33 years old female at 24 weeks gestation with partial molar pregnancy and right upper quadrant pain.



Theca Lutein Cyst



The imaging of adnexal masses represents a challenge and is very important to characterize the lesion with accuracy in the way to rule out malignancy.

Pelvic ultrasound is frequently the first imaging modality used when abnormalities are suspected of the ovaries or adnexa [­1].

The goal of ultrasound evaluation in the pregnant patient with an adnexal mass is to identify those patients in whom conservative management is appropriate versus those who require more immediate interventions such as surgery [2].

Ovarian conditions unique to pregnancy include hyperstimulated ovaries and, less commonly, ovarian hyperstimulation syndrome, hyperrreactio luteinalis, theca lutein cysts, and luteoma of pregnancy. These conditions, with the exception of luteoma of pregnancy, are tipically bilateral, aiding in their recognition [2].

Theca lutein cysts typically appear as bilateral cystic masses with multiple septations[3]. They are believed to be caused by an ovarian response to high levels of human chorionic gonadotropin. One would likely suspect theca lutein cysts by their typical appearance, although having an appropriate clinical history is helpful in making a more confident diagnosis [1].

Their sonographic appearance is that of bilateral enlarged ovaries with generous vascular stroma and multiple simple or minimally complicated cysts that may have undergone hemorrhage. The ovarian stroma may appear echogenic and relatively central, surrounded by multiple cysts, resulting in a characteristic “spoke wheel” appearance [4]. The enlarged ovaries are predisposed to torsion and hemorrhage. The incidence of torsion is reported between 3% and 16% [5].

Theca lutein cysts are associated with gestational trophoblastic disease but can occasionally be seen with a multiple pregnancy, fetal hydrops, or a normal singleton pregnancy (known as hyperreactioluteinalis) [6]. This appearance is also the same as seen with ovarion hyperstimulation syndrome during assisted reproductive thecniques[6]. After the high human chorionic gonadotropin stimulus for their formation is removed, it may take several weeks for the cysts to resolved [1].

References / Suggested Reading: 




  • Brown D. A practical approach to the ultrasound characterization of adnexal masses. Ultrasound Quarterly 2007; 23: 87-105.
  • Glanc Phyllis, MD, Salem Shia, MD, Farine Dan, MD. Adnexal Masses in the Pregnant Patient. Ultrasound Quarterly 2008; 24: 225-240.
  • Fried AM, Kenney CM, Stigers KB, et al. Benign pelvic masses: sonographic spectrum. Radiographics. 1996; 16: 321- 334.
  • Foulk RA, Martin MC, Jerkins GL, et al. Hyperreactio luteinalis differentiated from severe ovarian hyperstimulation syndrome in aspontaneous conceived pregnancy. Am J Obstet Gynecol. 1997; 176: 1300 - 1304.
  • Mashiach S, Bider D, Moran O, et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990; 53: 76 - 80.
  • Al-Harbi O, al-Saleem A, al-Tayeb O, et al. Recurrent bilateral theca lutein cysts in association with normal pregnancy. Ultrasound Obstet Gynecol. 1998; 11: 222- 224


THECA LUTEIN CYST, Daniel Mauricio Alvarez, Eranga Perera, Shweta Bhatt and Vikram S Dogra,MD., Imaging Science Today, 2010, 1794.