Ovarian Torsion With Ruptured Ovarian Haemorrhage With Massive Hemoperitoneum In A Case Of ITP

Idiopathic thrombocytopenic purpura, an immune-mediated disease, usually has a relatively benign clinical course. Bleeding manifestations are mostly mucocutaneous and mild. Massive hemorrhage requiring transfusions or other interventions are rare, unless platelet counts are extremely low or other complicating conditions coexist. We describe a 24year old woman, case of chronic ITP presenting with severe abdominal pain prompting an urgent Ultrasound and MR examination which showed ovarian torsion with ruptured ovarian hemorrhage causing massive hemoperitoneum. The specific sign of torsion is demonstration of multiple follicles of uniform size (8-12 mm in diameter) in the cortical peripheral portion of a unilaterally enlarged ovary. MR imaging showed enlarged ovary with peripherally situated T2 hyperintense follicles and ruptured ovarian capsule with better demonstration of pedicle. Large amount of subacute blood noted in peritoneal cavity suggested by hyperintensity on both T1 and T2.