Ovarian cyst

Background

• 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

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)
• GU
  • Ectopic
  • Endometriosis
  • Kidney stone
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • PID
  • Pyelonephritis
• Other
  • Abdominal aortic aneurysm
  • Epiploic appendagitis
  • Mesenteric lymphadenitis
  • Herpes zoster
  • Psoas abscess
  • Testicular torsion

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

Workup

• CBC, chemistry
• UA, urine pregnancy
• Pelvic ultrasound
• Consider CT A/P to rule out other etiologies (e.g. appendicitis)

Diagnosis

Ultrasound demonstrates a simple ovarian cyst greater than 3 cm in size consistent with a follicular cyst.

Transvaginal ultrasound showing ovarian cyst

• 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
• 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

• Abdominal Pain