Ovarian cyst
Background

Relative incidences of different types of ovarian cysts.[1]
- Most common are functional or follicular cysts
- Less common include PCOS, cystadenomas, and dermoid cysts
- Cysts are generally >1cm in size
- Cysts are at risk of torsion when >4cm
- Cysts <2cm are virtually risk free from torsion
Clinical Features
- Most tend to be asymptomatic
- Can cause:
- Dull pelvic pain or fullness; they can be significantly painful if ruptured
- Dyspareunia
- Pressure on the bladder
- If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of peritonitis, shock
Differential Diagnosis
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants may be noted on exam but generally do not cause pain or other symptoms
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervial Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Pelvic organ prolapse
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Evaluation

Transvaginal ultrasound showing ovarian cyst[3]

Ruptured hemorrhagic cyst. (a) CT with bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). (b) Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right hemorrhagic ovarian cyst (white arrow).
Workup
- CBC, chemistry
- UA, urine pregnancy
- Pelvic ultrasound
- Consider CT A/P to rule out other etiologies (e.g. appendicitis)
Diagnosis
- Typically diagnosed on ultrasound, with same side of pain and absence of other concerning etiologies (e.g. negative UA, not pregnant)
- Check hemoglobin level to assess for blood loss
Management
- NSAIDs
- Oral contraceptives
- No benefit has been found though gynecology may suggest them[4]
- Ensure that patient does not have significant anemia/free fluid in pelvis
- Consider repeat hemoglobin of observation period if concern for ruptured cyst with significant bleeding
Disposition
- Home, unlessed ruptured with concern for significant blood loss
- Follow up with OBGyn
See Also
External Links
References
- ↑ Abduljabbar, Hassan S.; Bukhari, Yasir A.; Hachim, Estabrq G. Al; Ashour, Ghazal S.; Amer, Afnan A.; Shaikhoon, Mohammed M.; Khojah, Mohammed I. (July 2015). "Review of 244 cases of ovarian cysts". Saudi Medical Journal. 36 (7): 834–838. doi:10.15537/smj.2015.7.11690. PMC 4503903. PMID 26108588.
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ http://www.thepocusatlas.com/obgyn/
- ↑ Cochrane Database Syst Rev 2011. Sep 7;(9):CD006134.