Diagnosis
H&P
Functional ovarian cysts.
DDx of ovarian cyst / Etiologies
DDx of adnexal mass.
Diagnostic tests
-Pregnancy test (for all peri- and premenopausal women); Serial quantitative β-hCG if an ectopic pregnancy is suspected.
-CBC with diff to r/o infection.
-U/S
Treatment
Algorithm.
Sample case:
You perform a PE on a 42-year-old female and notice a fullness in the left adnexal region that is mildly tender to palpation. Pelvic U/S shows a 4×5-cm cystic structure on the right ovary. The cyst has no internal septations or echogenic internal structures. A urine pregnancy test is negative.
What’s the next step? Repeat pelvic ultrasonography in 8–10 weeks
“Functional ovarian cysts are estimated to be present in approximately 15% of menstruating women and are often found incidentally on a pelvic examination or on diagnostic imaging performed for other reasons. The majority of these lesions resolve spontaneously within two or three menstrual cycles and management should consist of follow-up ultrasonography 8–12 weeks after the cyst is identified. Cysts that are particularly symptomatic, have less than simple features, are >10 cm in size, or that persist longer than 12 weeks should be referred for consideration of diagnostic removal (cystectomy or oophorectomy depending on patient characteristics). Patients who carry a BRCA gene or who have a family history of ovarian cancer should also be considered for invasive testing sooner. Serum CA-125 testing is difficult to interpret in premenopausal patients, who frequently have elevated levels without evidence of a malignancy. In postmenopausal women with an ovarian cyst a CA-125 level >35 U/mL should prompt referral for removal.” ABFM critique.
Further Reading
Diagnosis and management of adnexal masses. Am Fam Physician 2016;93(8):676-681.