Ovarian Cyst

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Definition

- Fluid filled sac within ovary

 

Features

-  Can develop from any time neonatal to postmenopausal

-  Typically develop during infancy & adolescence (hormonal influence)

-  Abnormal prepubertal & postmenopausal

-  Most are functional & spontaneously resolve

 

Associated S/S

-  Most are asymptomatic

-  Abdominal or pelvic pain &/or distension

-  Common presentation to ED

-  Unilateral dull ache or heaviness

-  Theca lutein cysts often bilateral

-  Rupture

-   Sudden unilateral

-   May be associated with intercourse, exercise, trauma

-  Severe, sudden onset +/- nausea & vomiting: ovarian torsion

-  Pelvic pain

-  Menorrhagia

-  Dysmenorrhoea

-  Tenesmus

-  Dyspareunia

-  +/- palpation on bimanual exam

-  Features suggestive of Ca

-  Family Hx of ovarian Ca

-  PMHx breast/bowel Ca

-  Complex cyst on US (solid areas, nodules, loculated)

-  Ascities

-  Decreased risk if use of OCP

 

Cause

-  Premenopausal (usually benign)

-  Functional (follicle growth with rupture/ovulation)

-  Dermoid (teratoma)

-  Most common persistant ovarian cyst

-  Must DDx Ovarian Ca

-  PCOS

-  Endometriosis (endometrioma)

-  Pregnancy (corpus luteum)

-  PID (tubo-ovarian abscess)

-  Ovarian Ca

-  Postmenopausal

-  Fluid collection

-  Ovarian Ca

 

Complications

-  More likely if cyst >5cm (largest diameter)

-  Ovarian torsion

-  Rupture or haemorrhage into cyst --> pain

-  Haemorrhage --> haemoperitoneum --> peritonitis

-  Androgen excess (theca lutein cysts)

 

DDx

-  Corpus luteum

-  Ectopic pregnancy

-  Appendicitis

-  PID

-  UTI

 

Ix

-  Pelvic US

-  TV > TA

-   Better resolution, DDx of artifacts, tissue characterization

-   Also need TA to visualise overall pelvis (TV only true pelvis)

-  If >8ml fluid in POD can be seen

-  Simple: smooth internal capsule + clear contents, usually benign

-  Complex: irregular wall, solid components,

-  Color Doppler

-   Central vascular flow or flow along septations: Ovarian Ca

-   Peripheral flow: benign

-   DDx torsion

-  During pregnancy

-   Vast majority corpus luteum (physiological)

-  FBE

-  WBC: PID, UTI

-  Hb: Anaemia

-  U&E

-  +/- Coags: bleeding diathesis

-  Urine Dipstick + MCS

-  UTI

-  Beta HCG: exclude ectopic & pregnancy

-  +/- CA125: esp if postmenopausal: Ovarian Ca

 

Mx

-  Analgesia

-  NSAIDs more effective than Opiates (NSAIDs not used in Pregnancy)

-  Premenopausal non-pregnanct pt

-  Resolution spontaneously by 2-3 months

-  F/U Pelvic US 2-3months

-  +/- Gynae F/U

-  Pregnant

-  Corpus luteum will resolve after first trimester

-  F/U pelvic US 6/52 post partum to monitor cyst

-  If cyst suspicious refer Gynaecologist

-  Surgery

-  Potentially indicated if >5cm

-  Laparoscopy

-  +/- oophorectomy considered if large, painful, persistant

-  +/- hysterectomy if postmenopausal

 

 

 

References

 

emedicine.medscape.com/article/795877-overview

iame.com/online/ovary/ovary.html