Left pelvic tenderness and mass. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus. The uterine morphology is unremarkable. The endometrium measures 15 mm in thickness, within normal limits for a premenopausal patient in the secretory phase. It is homogeneously hyperintense on T2-weighted imaging and has normal endometrial/inner myometrial interface. The inner myometrium/junctional zone measures approximately 4 mm, within normal limits. It is well-defined. Punctate cystic focus in the fundus is non-specific.1.3 x 1.1 cm left uterine body intramural fibroid demonstrating postcontrast enhancement.Tiny nabothian cysts. Otherwise the cervical stroma is unremarkable.The right ovary measures 2.6 x 1.4 x 1.5 cm, within normal limits and contains several physiologic follicles. There is minimal adjacent free fluid.The left ovary measures 2.8 x 2.4 x 3.7 cm. It contains a 2.5 x 1.9 x 2.3 cm focal lesion demonstrating low T1 weighted signal intensity, high T2-weighted signal intensity with thin-walled peripheral enhancement and a crenulated contour, likely representing a corpus luteal cyst. Possible small nodular enhancing component may be related to collapsed cyst walls. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free pelvic fluid, within physiologic limits.BONES, SOFT TISSUES: In the lower left rectus abdominis muscle there is a 3.3 x 1.4 x 3.0 cm (series 15 image 37 and series 10 image 42). The lesion demonstrates low T2 weighted signal intensity and scattered punctate T1-weighted hyperintensity. The lesion involves the anterior half of the muscle with ill-defined margins between itself and the muscle as well as spiculated margins suggestive of desmoplastic reaction. On subtraction imaging there is suggestion of mild internal septal enhancement. OTHER: No significant abnormality noted.
1. 2.5 cm left ovarian lesion with imaging characteristics most compatible with a corpus luteal cyst. Follow-up pelvic ultrasound in 2-3 weeks is recommended to document resolution. 2. 3.3 cm lesion involving the lower left rectus abdominis muscle. It's imaging characteristics may represent c-section scar endometriosis with associated desmoplastic reaction or less likely dermoid given the increased T1 signal.