Lesson 6 (Part 2)

Question 1

What is the sonographic appearance of a follicular cyst? (4)

Answer 1

1. Anechoic
2. Thin walled
3. Posterior enhancement
4. Measures equal or > 3cm

Question 2

What is a follicular cyst also known as?

Answer 2

A simple cyst

Question 3

Is a follicular cyst larger or smaller than a follicle?

Answer 3

Larger

Question 4

Are follicular cysts usually unilateral or bilateral?

Answer 4

Unilateral

Question 5

Are follicular cysts symptomatic or asymptomatic?

Answer 5

Asymptomatic

Question 6

How are follicular cysts found on US?

Answer 6

Frequently incidentally

Question 7

How do you resolve a follicular cysts?

Answer 7

On its own
- this is why most radiologists/Gyn do not choose to follow up if it is not 3cm or greater especially if its an asymptomatic patient

Question 8

How do you get a corpus luteal cyst?

Answer 8

After ovulation Failure of absorption or excessive bleeding into corpus luteum

Question 9

How large is a corpus luteal cyst?

Answer 9

4-5cm

Question 10

What is more common follicular cysts of corpus luteal cysts?

Answer 10

Follicular cysts

Question 11

What is more symptomatic follicular cysts of corpus luteal cysts?

Answer 11

Corpus luteal cysts

Question 12

Are corpus luteal cysts unilateral or bilateral?

Answer 12

Unilateral

Question 13

What are corpus luteal cysts more prone to? (2)

Answer 13

1. Rupture

2. Hemorrhage

Question 14

What is a major symptom of corpus luteal cysts?

Answer 14

Pain

Question 15

What is a differential diagnosis for corpus luteal cysts?

Answer 15

Ectopic pregnancy

- if positive B-HCG and no intrauterine pregnancy seen

Question 16

What is the sonographic appearance of corpus luteum? (7)

Answer 16

1. Small
   - < 4cm
2. Hypoechoic or isoechoic
3. Cyst with low-level internal echoes
4. Usually thicker walls than a follicle
5. Crenulated appearance
   - fine edge
6. Peripheral rim of colour
   - ring of fire
7. Involutes before menstruation

Question 17

What is the sonographic appearance of corpus luteal cysts? (2)

Answer 17

1. > 4cm

2. If hemorrhage differing US appearances due to variable appearance of blood

Question 18

What is the largest of the functional ovarian cysts?

Answer 18

The theca luteal cysts

Question 19

What are theca luteal cysts associated with?

Answer 19

High levels of hCG

Question 20

Where do theca luteal cysts mostly occur? (2)

Answer 20

1. Gestational trophoblastic disease
2. Ovarian Hyperstimulation Syndrome
   - fertility complication

Question 21

Are theca luteal cysts unilateral or bilateral?

Answer 21

Bilateral

Question 22

What is the sonographic appearance of theca luteal cysts? (3)

Answer 22

1. Bilateral
2. Multilocular
   - looks like lots of different follicles within
3. Large

Question 23

What are 4 complications for functional cysts?

Answer 23

1. Hemorrhage
2. Enlargement
3. Rupture
4. Torsion

Question 24

What is a symptom from complications from functional cysts?

Answer 24

Acute pain

Question 25

What can occur in functional cysts?

Answer 25

Internal haemorrhage

Question 26

What is the most common corpus luteal cysts?

Answer 26

Hemorrhagic cysts

Question 27

What is the fundamental characteristic of a cyst?

Answer 27

Posterior enhancement

Question 28

How can we tell the difference between a follicular or corpus luteal cyst undergoing hemorrhage?

Answer 28

We cant

Question 29

What is a symptom of hemorrhagic cysts?

Answer 29

Acute onset of pelvic pain

Question 30

What is the appearance of an Acute Hemorrhagic Cyst? (5)

Answer 30

1. Hyper echoic 2. May mimic a solid mass 3. Smooth posterior wall 4. Posterior acoustic enhancement 5. Reticular - strands of blood

Question 31

Why are there so many different sonographic appearances of hemorrhagic cysts?

Answer 31

Appearance is based on the stage of clotting and blood changes as it ages - anechoic (new blood)—> reticular pattern —> hyper echoic —> can come back to anechoic

Question 32

Does Colour Doppler help with diagnosis of a hemorrhagic cyst?

Answer 32

Yes - will show peripheral vascularity within the wall - clot can move and show colour - a cyst shouldn't have an internal vascularity

Question 33

What could free fluid in the pelvis indicate?

Answer 33

Leaking or ruptures hemorrhagic cyst

Question 34

What are the differential diagnosis for a hemorrhagic cyst? (3)

Answer 34

1. Ruptured ectopic pregnancy 2. Corpus luteal 3. Endometrioma