Ovarian cyst - imaging findings

Imaging approach to ovarian cysts.
From Merrow AC Jr. Diagnostic Imaging: Pediatrics. 3rd ed. Elsevier; 2017.

1. Ovarian cysts – imaging findings

2. Terms follicle is < 3 cm physiologic in pre and post menarchal functional cyst is > 3 cm , up to 10 cm follicular cyst corpus luteal cyst

3. Q to ask with ovarian cyst could this be torsion? could this be neoplasm? could this be other pathology?

4. Functional cysts are unilocular  no septa no solid component may bleed internally

5. nodule, fat density, Ca++  always pathologic  consider different diagnosis

6. Follicular cysts simple cyst imperceptible wall transonic may have minimal debris

7. Corpus luteal cysts 2-4 mm thick crenulated wall hyperenhancing wall may bleed , rupture, cause hemoperitoneum

8. Hemorrhagic cysts – US echogenic debris progressing to anechoic lace-like pattern classic fluid-debris level sometimes maintained through transmission even if echogenic

9. Best imaging tools US – mainstay MRI – if suspected malignancy

10. Findings indicative of neoplasm MRI best > 3 mm thick septation > 3 mm thick wall (and a typical for corpus luteal cyst) nodule size > 5 cm

11. If doubt or atypical aspect on US regarding size, complexity repeat US within 4-6 weeks

12. For simple cyst: surgery or surveillance?  depends on size < 5 cm – US surveillance > 5 cm – risk of torsion, neoplasm  surgery, ovarian-sparing if benign