Sonographic Diagnostic : Cystic Masses & Physiologic Ovarian Cysts

This discussion of the transvaginal sonographic differential diagnoses of pelvic masses is organized according of the most frequently seen sonographic appearance of particular types of a pelvic mass  . If a particular pelvic mass has a spectrum of sonographic appearances, it is mentioned in more than one category.

This differentiating scheme should be used only as a general approach to the sonographic characterization of a pelvic mass. Sonographic findings must be correlated with the clinical ones. The sonographic depiction of morphology is helpful in determining the change that a mass is malignant. The presences of wall or septal irregularity, or papillary excrescences, correlate with the changes of malignancy.

Cystic Masses

Pelvic masses appearing as cystic adnexal masses on transvaginal sonography most often include physiologic (follicular or luteal) ovarian cysts, hydrosalpinges, endometriomas, and paraovarian cysts. Even with the similar sonography appearance of several types of cystic adnexal masses, the diagnostic possibilities can usually be narrowed to one or two entities based on clinical presentation and evaluation. In general, most cystic masses that arise within the pelvis are of ovarian origin. Depending on the referral population, physiologic ovarian cysts or hydrosalpinges will be the most common cystic pelvic masses encountered by the sinologist.

Physiologic Ovarian Cysts

Since functional cysts are usually asymptomatic, their precise incidence is unknown. They are most common during the reproductive years, but may occur at any age. Several types of cystic masses can result from abnormalities that occur at different stages of folliculogenesis. In general, follicular cysts occur either due to failure of a mature follicle to rupture at any time of ovulation, or following the collection of blood within the follicle after ovulation occurs (corpus luteum cysts). In most women, a mature follicle average size ranges from 15 – 20 mm.7,15 Follicular cysts of the ovary are usually larger than a mature follicle, ranging from 3 to 8 cm in size. Luteal cysts, compared to follicular cysts, usually have a thicker wall and tend to contain hemorrhagic areas. Patient with hemorrhagic cysts may experience the abrupt onset of lower abdominal or pelvic pain Because this story can also pertain o cases of ruptured ectopic pregnancy, it is important to obtain an accurate pregnancy test in phase patient.