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

LLQ Pain

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[1]
  • 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[2]
  • 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

References
  1. http://www.thepocusatlas.com/obgyn/
  2. Cochrane Database Syst Rev 2011. Sep 7;(9):CD006134.
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