{"id":383011,"date":"2024-08-21T00:01:00","date_gmt":"2024-08-20T22:01:00","guid":{"rendered":"https:\/\/medizinonline.com\/?p=383011"},"modified":"2024-07-24T08:50:58","modified_gmt":"2024-07-24T06:50:58","slug":"abdominal-pain-ovarian-cysts","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/abdominal-pain-ovarian-cysts\/","title":{"rendered":"Abdominal pain – Ovarian cysts"},"content":{"rendered":"\n

Ovarian cysts are cavities filled with fluid or tissue in the ovaries.\nThey occur in women of all ages, but are particularly common during hormonal fluctuations.\nIf large ovarian cysts burst or rupture, this is often associated with severe pain.\nBleeding in the abdomen can also occur, making surgery necessary. <\/strong><\/p>\n\n\n\n

Ovarian cysts are often found as an incidental finding during abdominal imaging examinations.\nThey occur in pre- and postmenopausal women.\nIndividual ovarian cysts are usually clinically silent and the risk of malignant degeneration is very low [1].\nHowever, the risk of malignancy in complex cysts and solid tissue proliferations is 23 to 25 times higher.\nIf ovarian cysts occur frequently in a woman, do not regress or become very large, a gynecological consultation is required [2].\nIn most cases, ovarian cysts are functional cysts and have hormonal causes that are associated with a disruption of follicular or corpus luteum development.Ovarian cysts are classified according to their dignity [3].\n Table 1 <\/strong>provides an overview. Simple cysts are usually asymptomatic.\nComplications with lower abdominal pain are common in cases of hemorrhage, cyst rupture, torsion (stem rotation) and breakthrough bleeding.\nAcute pain symptoms are then also possible. <\/p>\n

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Important differential diagnoses, which may also require acute treatment, are listed in Overview 1 <\/strong>.<\/p>\n

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Table 2<\/strong> summarizes the diagnostic procedure.<\/p>\n

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Sonographically <\/em>, the simple cysts are homogeneously echoloculated with dorsal acoustic enhancement.\nThe cyst wall may be delineated delicately.\nIncreased internal echoes, wall thickening or dorsal sound effacement indicate a cyst complication and require further clarification. <\/p>\n\n

It can be difficult to differentiate benign from malignant cystic changes on computed tomography<\/em> [4].\nFunctional cysts can appear fluid equivalent, after hemorrhages also with density values above 20 HU.\nIn Stein-Leventhal syndrome, several smaller cysts, usually less than 1.5 cm in diameter, lead to bilateral enlargement of the ovaries. <\/p>\n\n

Magnetic resonance imaging<\/em> shows ovarian cysts as thin-walled, fluid-equivalent structures with smooth boundaries.\nThe signal intensity is isointense to the urine in all native sequences.\nThey are normally smaller than 4 cm.\nThey can occur solitary, but also bilateral and multiple.\nIf they are larger than 4 cm and show septations, a malignant variant must be ruled out [5].\nHemorrhages lead to signal inhomogeneities of the cyst, stratification in the supine position on examination then occurs, occasionally also a hemosiderin ring with signal reduction.\nEmbryonic remnants of the Wolffian duct lead to cysts in the suspensory ligament of the ovaries (para\u00f6phoron, epo\u00f6phoron, Morgagni hydatid). <\/p>\n\n

Case studies<\/h3>\n\n

In case examples 1 (Fig. 1A)<\/strong> and 2 (Fig. 1B)<\/strong>, uncomplicated ovarian cysts can be delineated as incidental findings on magnetic resonance imaging (arrows).\nThey are visualized as homogeneously liquor-intensive. <\/p>\n

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Case 2 (Fig. 2A to 2D)<\/strong> shows an ovarian cyst on the right side on MRI, which indicates hemorrhage with low-signal liquid content.\nPost contrast medium, there is also a moderate circular signal increase in the cyst wall, indicating an accompanying inflammatory reaction.\nThe patient had increasing lower abdominal pain, right dominant.\nIn addition, a retroflexed uterus was found, which can cause alteration of the sacral plexus. <\/p>\n

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Case 3<\/strong> shows a young female patient with undulating pain symptoms in the pelvis on the left with an ovarian cyst with mirror formation as an indication of bleeding that has taken place and is no longer completely fresh (Fig. 3A and B) <\/strong>. The increase in signal in the contrast sequence indicates an incipient fibrous organization of the sedimentation.<\/p>\n

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Case study 4<\/strong> shows an uncomplicated ovarian cyst on the left (Fig. 4A)<\/strong> and ovarian cysts of different sizes on both sides (Fig. 4B and C) <\/strong>in two women between the ages of 40 and 50 in computed tomography scans; there were no relevant symptoms in either case.<\/p>\n

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Take-Home-Messages<\/strong><\/p>\n\n