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 atypical 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