A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Ovarian Cyst
Etiology: — Physiological cyst is less than or equal to 3 centimeters (ovarian follicle) — Functional cyst greater than or equal to 3 centimeters (follicular cyst, corpus luteum cyst)
Imaging US of Simple ovarian cyst: — Anechoic — Intraovarian or exophytic — Imperceptible wall, posterior acoustic enhancement, visible far wall
Imaging US of Hemorrhagic ovarian cyst: — Heterogenous mass with fine septations — As clot evolves it can have lace-like appearance which over time becomes thickened and irregular septae — Can be solid clot or have fluid-fluid level — No internal flow on US Color Doppler — Can cause hemoperitoneum
DDX: Mesenteric cyst, omental cyst, GI duplication
Complications: Functional cysts may have hemorrhage, rupture, cause ovarian torsion
Treatment: — Large (greater than 3 centimeters) or symptomatic cysts may undergo surgical resection — Smaller asymptomatic cysts are treated conservatively
Clinical: Hemorrrhagic ovarian cysts can cause abdominal pain or pelvic pain
Radiology Cases of Ovarian Cyst
Radiology Cases of Simple Ovarian Cyst
Axial CT with contrast of the pelvis shows a distended contrast-filled bladder in the center of the image and contrast in the distal left ureter adjacent to the normal left ovary and contrast in the distal right ureter adjacent to the right ovary which contains a round low density lesion in its center. There is also a small amount of physiologic free fluid in the pelvisTransverse transabdominal US of the pelvis (above) shows a round mass of mixed echogenicity that is inferior to the bladder and to the right of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature with several much smaller cysts around it.Transverse transabdominal US of the pelvis (above) shows a round anechoic mass that is inferior to the bladder and to the left of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature.
Radiology Cases of Right Paraovarian Cyst and Left Simple Ovarian Cyst
Coronal (left) and axial (above left) CT with contrast of the abdomen shows a large, simple, fluid-filled structure above the bladder which is arising from the left ovary. Axial CT (below right) obtained more inferiorly shows a second, smaller, fluid-filled structure in the midline between the uterus and rectum which is in close association with the right ovary which is just to the right of the uterus.
Radiology Cases of Hemorrhagic Ovarian Cyst
Sagittal transabdominal US of the pelvis shows a diffusely hyperechoic mass in the right adnexa that was within the right ovary.
Radiology Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion
T1 coronal (left) and T1 sagittal (right) and T2 axial (below) MRI images show a heterogeneous intraperitoneal mass that appears to have hemorrhagic and calcified components. In the operating room this mass was found to be torsed.Transverse US of the fetus (above) shows an anechoic mass in the left side of the abdomen anteriorly. Post natal sagittal US images of the mass (below) show the mass to have mixed cystic and solid components.
Radiology Cases of Ovarian Cyst Causing Ovarian Torsion
Sagittal grayscale US of the right ovary (above) shows the right ovary to be enlarged and to contain a large central hypoechoic cyst. The right ovary was 4 times larger in size than the normal left ovary. Sagittal spectral doppler US of the right ovary (below) shows arterial flow to be present in the right ovary, but the amount of arterial flow was decreased when compared to the arterial flow to the left ovary.
Surgery Cases of Ovarian Cyst
Surgery Cases of Ovarian Cyst Causing Ovarian Torsion
Surgical laparoscopic image (above) shows an enlarged grayish-white necrotic appearing right ovary in the midline of the pelvis in the center of the image. Upon closer inspection (below) the pedicle of the right ovary is seen to be twisted.
Surgery Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion
Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.
Gross Pathology of Ovarian Cyst
Gross Pathology of Neonatal Ovarian Cyst Causing Ovarian Torsion
Gross pathological image (above) shows the mass to be circular and cystic. Upon sectioning, the thin-walled cyst was filled with hemorrhagic, fibrinous material (below). Solid areas were not present.Gross pathological image shows the mass to be circular and cystic (above). Upon sectioning, the thin-walled cyst was filled with hemorrhagic and fibrinous material (below).
Histopathology Cases of Ovarian Cyst
Histopathology Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion
Histopathological image H&E stained section shows a fibrous-walled cyst with few inflammatory cells and blood vessels filled with acellular fibrin; residual ovarian tissue was not identified.
