10/6/2016

OvarianCystsClinicalPresentation:History,PhysicalExamination

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OvarianCystsClinicalPresentation
Author:ShannonMGrabosch,MDChiefEditor:NicoleWKarjane,MDmore...
Updated:Sep20,2016

History
Mostpatientswithovariancystsareasymptomatic,withthecystsbeingdiscovered
incidentallyduringultrasonographyorroutinepelvicexamination.Somecysts,
however,maybeassociatedwitharangeofsymptoms,sometimessevere, [1]
althoughmalignantovariancystscommonlydonotcausesymptomsuntilthey
reachanadvancedstage.
Painordiscomfortmayoccurinthelowerabdomen.Torsion(twisting)orrupture
mayleadtomoreseverepain.Cystruptureischaracterizedbysudden,unilateral,
sharppelvicpain.Thiscanbeassociatedwithtrauma,exercise,orcoitus. [1,2]In
addition,cystrupturecanleadtoperitonealsigns,abdominaldistention,and
bleedingthatisusuallyselflimited.
Othersymptomsincludethefollowing:
Patientsmayexperiencediscomfortwithintercourse,particularlydeep
penetration

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OvarianCystsClinicalPresentation:History,PhysicalExamination

Havingbowelmovementsmaybedifficult,orpressuremaydevelop,leading
toadesiretodefecate
Micturitionmayoccurfrequently,duetopressureonthebladder
Irregularityofthemenstrualcycleandabnormalvaginalbleedingmayoccur
theintermenstrualintervalmaybeprolonged,followedbymenorrhagia [3]
Youngchildrenmaypresentwithprecociouspubertyandearlyonsetof
menarche
Patientsmayexperienceabdominalfullnessandbloating
Patientsmayexperienceindigestion,heartburn,orearlysatiety
Endometriomasareassociatedwithendometriosis,whichcausesaclassic
triadofpainfulandheavyperiodsanddyspareunia
Polycysticovariesmaybepartofthepolycysticovariansyndrome,which
includeshirsutism,infertility,oligomenorrhea,obesity,andacne
Somepatientsmayexperiencetenesmus
Thecaluteincystsarecommonlybilateralandthuscancausebilateral,dullpelvic
pain. [4]Thesecystsmaybeassociatedwithexcessstimulation,asisseenin
pregnancy(inparticulartwins),alargeplacenta,anddiabetes.Newbornsmayalso
developthecaluteincysts,duetotheeffectsofmaternalgonadotropins.Inrare
cases,thesecystsmaydevelopinthesettingofhypothyroidism,owingto
similaritiesbetweenthealphasubunitofTSHandhCG. [4,11]

PhysicalExamination
Palpation
Alargecystmaybepalpableonabdominalexamination,butgrossascitesmay
interferewithpalpationofanintraabdominalmass.
Althoughnormalovariesmaybepalpableduringthepelvicexaminationinthin,
premenopausalpatients,apalpableovaryshouldbeconsideredabnormalina
postmenopausalwoman.Ifapatientisobese,palpatingcystsofanysizemay
provedifficult.
Sometimes,discerningthecysticnatureofanovariancystmaybepossible,andit
maybetendertopalpation.Thecervixanduterusmaybepushedtooneside.
Othermassesmaybepalpable,includingfibroidsandnodulesintheuterosacral
ligamentconsistentwithmalignancyorendometriosis.

Othersymptoms
Hemorrhageduetocystrupturemayleadtotachycardiaandhypotension.Blood
pressuremonitoringmayshoworthostatichypotension.
Somecomplicationsofovariancysts,suchasovariantorsion,mayresultin
hyperpyrexia. [1]
Examinationrevealsmoderatetosevereunilateralorbilaterallowerabdominal
tendernessinsomewomenwithanovariancyst.
Somecomplicationsofovariancystsmayresultinadnexaltendernessorcervical
motiontenderness.However,pelvicexaminationrevealsthatupto88%ofovarian
cystsarebenign. [24]
Ifhemorrhageorperitonitisensues,thepatientmaypresentwithadiffuselytender
abdomenwithreboundtendernessandguardinginaddition,adistendedabdomen
maybefoundonabdominalexamination.
Advancedmalignantdiseasemaybeassociatedwithcachexiaandweightloss,
lymphadenopathyintheneck,shortnessofbreath,andsignsofpleuraleffusion.
DifferentialDiagnoses

ContributorInformationandDisclosures
Author
ShannonMGrabosch,MDFellowinGynecologicOncology,MageeWomensHospital,UniversityofPittsburgh
MedicalCenter
ShannonMGrabosch,MDisamemberofthefollowingmedicalsocieties:AmericanAssociationforCancer
Research,AmericanAssociationofGynecologicLaparoscopists,AmericanAssociationofImmunologists,
AmericanCollegeofObstetriciansandGynecologists,AmericanSocietyofClinicalOncology,Societyfor
ImmunotherapyofCancer,SocietyofGynecologicOncology
Disclosure:Nothingtodisclose.
Coauthor(s)
CWilliamHelm,MBBCh,MA,FRCS,FRCS(Edin)Consultant,RoyalCornwallHospital,UK
CWilliamHelm,MBBCh,MA,FRCS,FRCS(Edin)isamemberofthefollowingmedicalsocieties:American
CollegeofObstetriciansandGynecologists,EuropeanSocietyofGynaecologicalOncology,International
GynecologicCancerSociety
Disclosure:Nothingtodisclose.
ChiefEditor

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OvarianCystsClinicalPresentation:History,PhysicalExamination

NicoleWKarjane,MDAssociateProfessor,DepartmentofObstetricsandGynecology,VirginiaCommonwealth
UniversityMedicalCenter
NicoleWKarjane,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AssociationofProfessorsofGynecologyandObstetrics,NorthAmericanSocietyforPediatricand
AdolescentGynecology
Disclosure:Nothingtodisclose.
Acknowledgements
KimberlyDuklewskiAbel,MDStaffPhysician,DepartmentofEmergencyMedicine,FranklinMemorial
Hospital,CarilionHealthSystem
Disclosure:Nothingtodisclose.
AndrewAAronson,MD,FACEPVicePresident,PhysicianPractices,BravoHealthAdvancedCareCenter
ConsultingStaff,DepartmentofEmergencyMedicine,TaylorHospital,RidleyPark,Pennsylvania
AndrewAAronson,MD,FACEPisamemberofthefollowingmedicalsocieties:AmericanCollegeof
EmergencyPhysicians,MassachusettsMedicalSociety,andSocietyofHospitalMedicine
Disclosure:Nothingtodisclose.
ADavidBarnes,MD,PhD,MPH,FACOGConsultingStaff,DepartmentofObstetricsandGynecology,
MammothHospital(MammothLakes,California),PioneerValleyHospital(SaltLakeCity,Utah),WarrenGeneral
Hospital(Warren,Pennsylvania),andMountainWestHospital(Tooele,Utah)
ADavidBarnes,MD,PhD,MPH,FACOGisamemberofthefollowingmedicalsocieties:AmericanCollegeof
ForensicExaminers,AmericanCollegeofObstetriciansandGynecologists,AmericanMedicalAssociation,
AssociationofMilitarySurgeonsoftheUS,andUtahMedicalAssociation
Disclosure:Nothingtodisclose.
PamelaLDyne,MDProfessorofClinicalMedicine/EmergencyMedicine,DavidGeffenSchoolofMedicineat
UCLAAttendingPhysician,DepartmentofEmergencyMedicine,OliveViewUCLAMedicalCenter
PamelaLDyne,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine,
AmericanCollegeofEmergencyPhysicians,andSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
AAntoineKazzi,MDDeputyChiefofStaff,AmericanUniversityofBeirutMedicalCenterAssociateProfessor,
DepartmentofEmergencyMedicine,AmericanUniversityofBeirut,Lebanon
AAntoineKazzi,MDamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine,
AmericanCollegeofEmergencyPhysicians,andSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
MarkASilverberg,MD,FACEP,MMBAssistantProfessor,AssistantResidencyDirector,Departmentof
EmergencyMedicine,StateUniversityofNewYorkDownstateCollegeofMedicineConsultingStaff,
DepartmentofEmergencyMedicine,StatenIslandUniversityHospital,KingsCountyHospital,University
Hospital,StateUniversityofNewYorkDownstateatBrooklyn
MarkASilverberg,MD,FACEP,MMBisamemberofthefollowingmedicalsocieties:AmericanCollegeof
EmergencyPhysicians,AmericanMedicalAssociation,CouncilofEmergencyMedicineResidencyDirectors,and
SocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
DanaAStearns,MDAssistantDirectorofUndergraduateEducation,DepartmentofEmergencyMedicine,
MassachusettsGeneralHospital
DanaAStearns,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine
andAmericanCollegeofEmergencyPhysicians
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeDrugs&DiseasesSalaryEmployment
WalterWValeskyJr,MDClinicalAssistantInstructor,DepartmentofEmergencyMedicine,StateUniversityof
NewYorkDownstate,Brooklyn
Disclosure:Nothingtodisclose.
MarkZwanger,MD,MBAAssistantProfessor,DepartmentofEmergencyMedicine,ThomasJefferson
University
MarkZwanger,MD,MBAisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine,AmericanCollegeofEmergencyPhysicians,andAmericanMedicalAssociation
Disclosure:Nothingtodisclose.

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