A 26-year-old nulligravid woman presents to the emergency department with sudden-onset severe right lower quadrant pain that began 4 hours ago while exercising. She reports similar milder episodes over the past 6 weeks that resolved spontaneously. She is tachycardic (HR 108), mildly febrile (38.1 °C), with guarding and rebound tenderness in the right iliac fossa. Pelvic ultrasound is performed. The structure marked **A** in the diagram shows a markedly enlarged ovary measuring 8.2 × 6.4 × 5.1 cm with uniformly edematous echogenic stroma and peripherally displaced follicles in a "string-of-pearls" pattern. The contralateral ovary is normal. Which of the following best explains the sonographic appearance of the structure marked **A**?
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