Kissing ovaries sign on MRI

Excerpt

Para-ovarian adhesions caused by endometriosis can result in the ovaries being situated adjacent to each other near midline in the pouch of Douglas. When imaging studies depict this finding, it is known as the ‘kissing ovaries’ sign [1] (Figs. 1, 2 and video 1 in Supplementary material). This sign has been described on ultrasound as well as MRI. The kissing ovaries are similar to the lovers in the Rodin’s “The Kiss” sculpture [Fig. 3]. Identification of kissing ovaries at ultrasound is strongly correlated related with endometriosis, and indeed is a marker of severe endometriosis [2]. Ovarian endometriomas are bilateral in more than 50% of patients, often multilocular, and accompanied by inter- or peri-ovarian adhesions [3]. Blood products within the hematosalpinx, which is commonly seen in endometriosis, may cause adhesions to fold or pull the ovaries and fallopian tubes toward the midline [2, 3]. Other indirect indicators of pelvic adhesions in endometriosis include posteriorly displaced uterus, elevated posterior vaginal fornix, angulated small bowel loops, absent sliding of viscera, hematosalpinx and multilocular pelvic fluid collections [4]. Pyosalpinx also can produce pelvic adhesions and the kissing ovaries sign but MR imaging can be helpful in differentiating the two [3].

…