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Pediatrics
Diagnosis
Genitourinary
Uterine and Ovarian Abnormalities
Ovarian Cyst
Ovarian Cyst
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Follicle, functional or follicular cyst, ovulatory cyst

          • Definitions

            • Well-marginated, round or ovoid structure within or at borders of ovary; no solid component
              • No fat, Ca²⁺, or septa
              • Thin, imperceptible wall (< 3 mm thick)
              • May appear more complex after internal hemorrhage
              • No internal vascularity on color Doppler imaging
            • Definitions of different cyst types & their sizes vary
              • Follicle
                • Generally < 1 cm in diameter
                • Dominant follicle may measure up to 3 cm
              • Functional cysts
                • Corpus luteal cyst
                  • After ovulation, dominant follicle becomes corpus luteal cyst
                  • Usually < 3 cm, though can be much larger
                • Follicular cyst
                  • Occurs when normal mature follicle fails to ovulate/involute
                  • Usually 3-10 cm
              • Hemorrhagic cyst
                • Hemorrhage occurs into one of above

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Abdelmeguid Y et al: Huge ovarian cyst in a neonate with classical 21-hydroxylase deficiency. Clin Pediatr Endocrinol. 30(1):57-60, 2021
                                      2. Kitami M et al: "Follow the fallopian tube": a technique to improve sonographic identification of ovaries in children. J Clin Ultrasound. 49(1):33-7, 2021
                                      3. Xac MC et al: Benign, borderline, and malignant pediatric adnexal masses: a ten-year review. J Pediatr Adolesc Gynecol. 34(4):454-61, 2021
                                      4. Kodikara H et al: Massive, benign, cystic ovarian tumors: a technical modification for minimally invasive resection. J Pediatr Surg.56(2):417-9, 2020
                                      5. Magistrado L et al: Paratubal cyst recurrence in children and adolescents. J Pediatr Adolesc Gynecol. 33(6):649-51, 2020
                                      6. Peeraully R et al: Effect of surgical specialty on management of adnexal masses in children and adolescents: an 8-year single-center review. J Pediatr Adolesc Gynecol. 33(1):89-92, 2020
                                      7. Riaz M et al: Van Wyk Grumbach syndrome. J Coll Physicians Surg Pak. 30(12):1332-4, 2020
                                      8. Caprio MG et al: Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound. 22(3):273-89, 2019
                                      9. Schallert EK et al: Physiologic ovarian cysts versus other ovarian and adnexal pathologic changes in the preadolescent and adolescent population: US and surgical follow-up. Radiology. 292(1):172-8, 2019
                                      10. Gonzalez DO et al: Management of benign ovarian lesions in girls: a trend toward fewer oophorectomies. Curr Opin Obstet Gynecol. 29(5):289-94, 2017
                                      11. Naffaa L et al: Imaging of acute pelvic pain in girls: ovarian torsion and beyond☆. Curr Probl Diagn Radiol. 46(4):317-29, 2017
                                      12. Trotman GE et al: Rate of oophorectomy for benign indications in a children's hospital: influence of a gynecologist. J Pediatr Adolesc Gynecol. 30(2):234-8, 2017
                                      13. Madenci AL et al: Preoperative risk stratification of children with ovarian tumors. J Pediatr Surg. 51(9):1507-12, 2016
                                      14. Bronstein ME et al: A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 25(1):82-6, 2015
                                      15. Cho MJ et al: Ovarian cyst aspiration in the neonate: minimally invasive surgery. J Pediatr Adolesc Gynecol. 28(5):348-53, 2015
                                      16. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                      17. Asăvoaie C et al: Ovarian and uterine ultrasonography in pediatric patients. Pictorial essay. Med Ultrason. 16(2):160-7, 2014
                                      18. Papic JC et al: Management of neonatal ovarian cysts and its effect on ovarian preservation. J Pediatr Surg. 49(6):990-3; discussion 993-4, 2014
                                      19. Youngster M et al: Utility of ultrasound in the diagnosis of polycystic ovary syndrome in adolescents. Fertil Steril. 102(5):1432-8, 2014
                                      20. Tessiatore P et al: When to operate on ovarian cysts in children? J Pediatr Endocrinol Metab. 25(5-6):427-33, 2012
                                      21. Muolokwu E et al: The incidence and surgical management of paratubal cysts in a pediatric and adolescent population. J Pediatr Surg. 46(11):2161-3, 2011
                                      22. Levine D et al: Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 256(3):943-54, 2010
                                      23. Bekiesińska-Figatowska M et al: Magnetic resonance imaging as a diagnostic tool in case of ovarian masses in girls and young women. Med Sci Monit. 13 Suppl 1:116-20, 2007
                                      24. Brandt ML et al: Ovarian cysts in infants and children. Semin Pediatr Surg. 14(2):78-85, 2005
                                      25. Borders RJ et al: Computed tomography of corpus luteal cysts. J Comput Assist Tomogr. 28(3):340-2, 2004
                                      26. Strickland JL: Ovarian cysts in neonates, children and adolescents. Curr Opin Obstet Gynecol. 14(5):459-65, 2002
                                      27. Cohen HL et al: Ovarian cysts are common in premenarchal girls: a sonographic study of 101 children 2-12 years old. AJR Am J Roentgenol. 159(1):89-91, 1992
                                      28. Surratt JT et al: Imaging of pediatric ovarian masses. Radiographics. 11(4):533-48, 1991
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Synonyms

                                                • Follicle, functional or follicular cyst, ovulatory cyst

                                              • Definitions

                                                • Well-marginated, round or ovoid structure within or at borders of ovary; no solid component
                                                  • No fat, Ca²⁺, or septa
                                                  • Thin, imperceptible wall (< 3 mm thick)
                                                  • May appear more complex after internal hemorrhage
                                                  • No internal vascularity on color Doppler imaging
                                                • Definitions of different cyst types & their sizes vary
                                                  • Follicle
                                                    • Generally < 1 cm in diameter
                                                    • Dominant follicle may measure up to 3 cm
                                                  • Functional cysts
                                                    • Corpus luteal cyst
                                                      • After ovulation, dominant follicle becomes corpus luteal cyst
                                                      • Usually < 3 cm, though can be much larger
                                                    • Follicular cyst
                                                      • Occurs when normal mature follicle fails to ovulate/involute
                                                      • Usually 3-10 cm
                                                  • Hemorrhagic cyst
                                                    • Hemorrhage occurs into one of above

                                              IMAGING

                                              • General Features

                                                • Ultrasonographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Abdelmeguid Y et al: Huge ovarian cyst in a neonate with classical 21-hydroxylase deficiency. Clin Pediatr Endocrinol. 30(1):57-60, 2021
                                                                          2. Kitami M et al: "Follow the fallopian tube": a technique to improve sonographic identification of ovaries in children. J Clin Ultrasound. 49(1):33-7, 2021
                                                                          3. Xac MC et al: Benign, borderline, and malignant pediatric adnexal masses: a ten-year review. J Pediatr Adolesc Gynecol. 34(4):454-61, 2021
                                                                          4. Kodikara H et al: Massive, benign, cystic ovarian tumors: a technical modification for minimally invasive resection. J Pediatr Surg.56(2):417-9, 2020
                                                                          5. Magistrado L et al: Paratubal cyst recurrence in children and adolescents. J Pediatr Adolesc Gynecol. 33(6):649-51, 2020
                                                                          6. Peeraully R et al: Effect of surgical specialty on management of adnexal masses in children and adolescents: an 8-year single-center review. J Pediatr Adolesc Gynecol. 33(1):89-92, 2020
                                                                          7. Riaz M et al: Van Wyk Grumbach syndrome. J Coll Physicians Surg Pak. 30(12):1332-4, 2020
                                                                          8. Caprio MG et al: Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound. 22(3):273-89, 2019
                                                                          9. Schallert EK et al: Physiologic ovarian cysts versus other ovarian and adnexal pathologic changes in the preadolescent and adolescent population: US and surgical follow-up. Radiology. 292(1):172-8, 2019
                                                                          10. Gonzalez DO et al: Management of benign ovarian lesions in girls: a trend toward fewer oophorectomies. Curr Opin Obstet Gynecol. 29(5):289-94, 2017
                                                                          11. Naffaa L et al: Imaging of acute pelvic pain in girls: ovarian torsion and beyond☆. Curr Probl Diagn Radiol. 46(4):317-29, 2017
                                                                          12. Trotman GE et al: Rate of oophorectomy for benign indications in a children's hospital: influence of a gynecologist. J Pediatr Adolesc Gynecol. 30(2):234-8, 2017
                                                                          13. Madenci AL et al: Preoperative risk stratification of children with ovarian tumors. J Pediatr Surg. 51(9):1507-12, 2016
                                                                          14. Bronstein ME et al: A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 25(1):82-6, 2015
                                                                          15. Cho MJ et al: Ovarian cyst aspiration in the neonate: minimally invasive surgery. J Pediatr Adolesc Gynecol. 28(5):348-53, 2015
                                                                          16. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                                                          17. Asăvoaie C et al: Ovarian and uterine ultrasonography in pediatric patients. Pictorial essay. Med Ultrason. 16(2):160-7, 2014
                                                                          18. Papic JC et al: Management of neonatal ovarian cysts and its effect on ovarian preservation. J Pediatr Surg. 49(6):990-3; discussion 993-4, 2014
                                                                          19. Youngster M et al: Utility of ultrasound in the diagnosis of polycystic ovary syndrome in adolescents. Fertil Steril. 102(5):1432-8, 2014
                                                                          20. Tessiatore P et al: When to operate on ovarian cysts in children? J Pediatr Endocrinol Metab. 25(5-6):427-33, 2012
                                                                          21. Muolokwu E et al: The incidence and surgical management of paratubal cysts in a pediatric and adolescent population. J Pediatr Surg. 46(11):2161-3, 2011
                                                                          22. Levine D et al: Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 256(3):943-54, 2010
                                                                          23. Bekiesińska-Figatowska M et al: Magnetic resonance imaging as a diagnostic tool in case of ovarian masses in girls and young women. Med Sci Monit. 13 Suppl 1:116-20, 2007
                                                                          24. Brandt ML et al: Ovarian cysts in infants and children. Semin Pediatr Surg. 14(2):78-85, 2005
                                                                          25. Borders RJ et al: Computed tomography of corpus luteal cysts. J Comput Assist Tomogr. 28(3):340-2, 2004
                                                                          26. Strickland JL: Ovarian cysts in neonates, children and adolescents. Curr Opin Obstet Gynecol. 14(5):459-65, 2002
                                                                          27. Cohen HL et al: Ovarian cysts are common in premenarchal girls: a sonographic study of 101 children 2-12 years old. AJR Am J Roentgenol. 159(1):89-91, 1992
                                                                          28. Surratt JT et al: Imaging of pediatric ovarian masses. Radiographics. 11(4):533-48, 1991