Hemorrhagic Ovarian Cyst (Fishnet Weave / Reticular Pattern)

Fishnet Weave / Reticular Pattern

A Hemorrhagic Ovarian Cyst (HOC) is a functional ovarian cyst that forms when a normal follicle or corpus luteum bleeds internally. It is not a tumor, not cancer, and usually resolves on its own within 6–12 weeks.

Cyst wall

The cyst wall is the outer boundary of the ovarian cyst, formed by stretched ovarian tissue or the capsule of a functional follicle/corpus luteum.

Sonographic characteristics:

• Thin or mildly thickened
• Smooth inner margins
• May show mild wall hyperemia
• No mural nodules (important — nodules = suspicious)

Clinical significance:A smooth thin wall supports a benign functional cyst. A thickened irregular wall may indicate infection, endometrioma, or neoplasm.

FIBRIN STRANDS (Fishnet / Reticular Pattern)

Fibrin strands are thin, web-like internal echoes created by the formation of fibrin as blood clots inside the cyst.

Sonographic characteristics:

• Thin, linear, curvilinear internal echoes
• Intersecting pattern (“fishnet”, “lace”, “reticular”)
• Avascular on Color Doppler
• May show subtle movement with probe pressure

Clinical significance: The presence of fine fibrin strands with a reticular or fishnet appearance is highly suggestive of a hemorrhagic ovarian cyst (HOC). This characteristic pattern helps differentiate HOC from:
Ovarian tumors — which typically contain vascular solid areas
Endometriomas — which show homogeneous “ground-glass” internal echoes

CLOT FRAGMENTS (Echogenic Debris)

Clot fragments are irregular echogenic masses formed from organizing blood inside the cyst.

Sonographic characteristics:

• Non-shadowing echogenic foci or masses
• May be mobile or layered
• No internal vascularity (key diagnostic point)
• Often settle in the dependent portion of the cyst

Clinical significance: These echogenic clot fragments strongly support the diagnosis of a hemorrhagic ovarian cyst. Their avascular nature helps differentiate them from vascular solid tumors. Typically, these clots resolve spontaneously within 6–12 weeks on follow-up sonography.

Why This Pattern Is Important

The fishnet pattern helps diagnose HOC confidently without mistaking it for:
1. Endometrioma ("ground glass" homogeneous pattern)
2. Tumors (vascular nodules)
3. Tubo-ovarian abscess (complex echogenicity)

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Hemorrhagic Ovarian Cyst — Bilingual MCQ Panel

Fishnet weave / Reticular pattern • Toggle language • Immediate feedback • 10 questions

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