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Ovarian cysts

Last updated: November 19, 2020

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Ovarian cysts are fluid-filled sacs within the ovary. The most common types are functional follicular cysts, corpus luteum cysts, and theca lutein cysts, which all develop as part of the menstrual cycle and are usually harmless and resolve on their own. Nonfunctional cysts include chocolate cysts, which are related to endometriosis, dermoid cysts, cystadenomas, and malignant cysts (a type of ovarian cancer). All types can be diagnosed via pelvic ultrasound. While ovarian cysts are usually asymptomatic, complications due to rupture of a cyst can occur and may require treatment. Moreover, individuals with ovarian cysts are at increased risk of ovarian torsion, which requires surgical correction.

Definition

Ovarian cysts are fluid-filled sacs within the ovary.

Types

Functional cysts

Functional cysts result from a disruption in the development of follicles or the corpus luteum and often resolve on their own.

Nonfunctional cysts

Clinical features

In premenarchal and postmenopausal patients with a palpable ovarian mass, ovarian cancer needs to be ruled out.

Diagnosis

Treatment

Complications

Etiology [1]

  • Rupture is caused by an increase in intracystic pressure.
  • Most common type of ruptured cyst: corpus luteum cyst [2]
  • Risk factors
    • Vigorous physical activity
    • Vaginal intercourse
    • Large cysts
    • Reproductive age

Clinical features

Diagnostics [3]

Laboratory studies

Imaging

Free fluid in the pouch of Douglas in a pregnant patient should raise concern for ruptured ectopic pregnancy (see ''Treatment'' in ectopic pregnancy).

Treatment [3][6][7]

Differential diagnoses

Acute management checklist for ruptured ovarian cyst

Definition

Etiology

Pathophysiology

Clinical features

Diagnostics

Laboratory studies

Imaging [4][8]

Treatment

Surgery with adnexal detorsion and preservation of ovaries is the mainstay of treatment.

Diagnostic laparoscopy should be performed if there is strong clinical suspicion for ovarian torsion despite inconclusive imaging findings.

Differential diagnoses

Acute management checklist for ovarian torsion [15]

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  2. Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010; 202 (6): p.536.e1-536.e6. doi: 10.1016/j.ajog.2009.11.028 . | Open in Read by QxMD
  3. Committee on Adolescent Health Care. Adnexal Torsion in Adolescents, ACOG Committee Opinion No. 783. Obstet Gynecol. 2019; 134 (2): p.e56-e63. doi: 10.1097/aog.0000000000003373 . | Open in Read by QxMD
  4. Liu YP et al.. Sudden onset of right lower quadrant pain after heavy exercise.. Am Fam Physician. 2008; 78 (3): p.379-80, 384.
  5. Yancey LM. Intermittent Torsion of a Normal Ovary in a Child Associated with Use of a Trampoline. J Emerg Med. 2012; 42 (4): p.409-412. doi: 10.1016/j.jemermed.2010.11.046 . | Open in Read by QxMD
  6. Bhosale PR et al.. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Q. 2016; 32 (2): p.108-115. doi: 10.1097/ruq.0000000000000200 . | Open in Read by QxMD
  7. Peña JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril. 2000; 73 (5): p.1047-1050. doi: 10.1016/s0015-0282(00)00487-8 . | Open in Read by QxMD
  8. Ashwal E et al.. Characteristics and Management of Ovarian Torsion in Premenarchal Compared With Postmenarchal Patients. Obstet Gynecol. 2015; 126 (3): p.514-520. doi: 10.1097/aog.0000000000000995 . | Open in Read by QxMD
  9. R Eskander, M Berman, L Keder. Practice Bulletin No. 174. Obstetrics & Gynecology. 2016; 128 (5): p.e210-e226. doi: 10.1097/aog.0000000000001768 . | Open in Read by QxMD
  10. Hartley J, Akhtar M, Edi-Osagie E. Oophoropexy for Recurrent Ovarian Torsion. Case Reports in Obstetrics and Gynecology. 2018; 2018 : p.1-4. doi: 10.1155/2018/8784958 . | Open in Read by QxMD
  11. Shiner A, Burbos N. Ovarian Cysts and Ovarian Cancer. InnovAiT. 2012; 5 (9): p.547-557. doi: 10.1093/innovait/ins130 . | Open in Read by QxMD
  12. Hertzberg BS et al.. Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis. Abdom Imaging. 1999; 24 (3): p.304-308. doi: 10.1007/s002619900502 . | Open in Read by QxMD
  13. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009; 23 (5): p.711-724. doi: 10.1016/j.bpobgyn.2009.02.001 . | Open in Read by QxMD
  14. Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies.. Insights into imaging. 2012; 3 (3): p.265-75. doi: 10.1007/s13244-012-0157-0 . | Open in Read by QxMD
  15. Lee JK, Bodur S, Guido R. The management of gynecological hemoperitoneum found to be associated with a ruptured corpus luteum cyst. Gynecol Surg. 2016; 13 (4): p.305-311. doi: 10.1007/s10397-016-0951-7 . | Open in Read by QxMD
  16. Kim JH, Lee SM, Lee J-H, et al. Successful Conservative Management of Ruptured Ovarian Cysts with Hemoperitoneum in Healthy Women. PLoS ONE. 2014; 9 (3): p.e91171. doi: 10.1371/journal.pone.0091171 . | Open in Read by QxMD