I-46: Ultrasound Guided Aspiration of Ovarian Cyst

Ultrasonography is the primary imaging tool for a patient considered to have an ovarian cyst. On a sonogram, simple ovarian cysts have a uniformly thin, rounded wall and a unilocular appearance that is either hypoechoic or anechoic. They usually measure 2.5-15 cm in diameter, and posterior acoustic enhancement (a hyperechoic area) may be visible deep to the fluid-filled cyst. Most commonly, they are functional follicular or luteal cysts or, less commonly, serous cystadenomas or inclusion cysts. Complex cysts may have more than 1 compartment (multilocular), thickening of the wall, projections (papulations) sticking into the lumen or on the surface, or abnormalities within the cyst contents. Malignant cysts usually fall within this category, as do many benign neoplastic cysts. According to a consensus statement by the society of radiologists in ultrasound, for simple ovarian cysts with no suspicious features on ultrasound, current follow-up guidelines state. In women of reproductive age. In post-menopausal women. Persistent simple ovarian cysts larger than 5-10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. The surgical approaches include an open incisional technique (laparotomy) and a minimally invasive technique (laparoscopy) with very small incisions. Sonographically guided therapeutic aspiration of symptomatic ovarian cysts is viable alternative to surgical extirpation; even in pregnant women. Fine needle aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. It is of particular use in pregnancy, and in patients unsuitable for laparoscopy or surgery. Surgery can be reserved for cysts which recur after aspiration, cysts with a hemorrhagic aspirate, cysts in post-menopausal women and those with ultrasonic criteria of malignancy. Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.