Hyperreactio luteinalis (HL) is typically associated with pregnancy or trophoblastic disease and form bilateral, multicystic lesions accompanied by elevated hCG levels. While HL is generally asymptomatic and treated conservatively, it can cause symptoms such as abdominal pain and nausea if complications like hemorrhage, rupture, or torsion occurs. Characteristically, HL appears bilaterally and the size of each cyst is relatively uniform. The internal fluid of cysts of HL usually serous. However, if hemorrhage leads to heterogeneous signals within the cysts, it can be challenging to differentiate them from mucinous tumors.