Fig. 2

MRI pelvis of a 17-year-old female with cyclic pelvic pain. Axial T1W SE image (a) shows a round hyperintense lesion (white arrow) in the right anterolateral myometrium, at the site of attachment of round ligament. Axial T2W SE image (b) reveals a thick-walled, round lesion with hypointense wall and shading of internal contents. Uterine endometrium is seen separately from the lesion. Both ovaries are normal (short white arrows). Corresponding axial T1W FS (c) and axial T2W FS (d) show no suppression of signal on fat saturated images, suggesting blood products. Axial T2* gradient-recalled echo (GRE) image (e) shows blooming of contents, confirming bleed. Axial T1W FS post-contrast image (f) shows isoenhancement of the wall relative to the myometrium. No enhancement of the intraluminal contents seen. Imaging features are suggestive of accessory and cavitated uterine mass (ACUM)