0:01

Okay, so what are the different manifestations

0:03

that we see in normal ovarian physiology?

0:07

Well, you can see here that we've got

0:08

a diagram of an ovary with multiple

0:12

different stages of follicular development.

0:15

So you can see a number of different cysts

0:19

over that time, so we'll call them cysts

0:21

even though they're physiologically normal,

0:24

and they range from a follicular cyst to

0:26

a corpus luteum cyst, to a hemorrhagic

0:29

cyst, and sometimes ovarian inclusion cyst.

0:32

And those are the main four stages that we

0:35

see, but there are even some stages in between.

0:38

As you can see from the diagram.

0:39

So depending on the stage of when the

0:42

patient is imaged, the ovary can have a very

0:45

dynamic appearance because of the variable

0:48

physiology and they're quite dynamic organs.

0:51

So it's important to keep that in mind when

0:53

you're evaluating patients with ultrasound and

0:56

MR, particularly in the premenopausal age group.

0:59

What are the commonly seen ovarian cysts?

1:02

And you'll see here that I have

1:04

cysts in quotation marks.

1:06

And that's because I don't necessarily want

1:08

to apply the label of a cyst, which may imply

1:11

some pathology to a normal appearance of an

1:15

ovary depending on its physiologic state.

1:18

So we tend to call these cysts'

1:20

appearances cysts, but keep in mind that

1:23

cysts can be normal or abnormal depending on

1:25

whether they fit with the ovarian physiology.

1:29

So here we've got a follicular cyst

1:31

and then we've got a corpus luteum,

1:33

or corpus albicans, hemorrhagic cyst,

1:36

endometrioma, and ovarian inclusion cyst.

1:40

And those are some of the different ultrasound

1:43

appearances you may see when scanning patients,

1:45

particularly in the premenopausal state.

1:48

So a follicular cyst is hormone

1:50

dependent, and it really develops because

1:53

of arrested follicular development.

1:56

So when the follicle stops growing, it's a you

1:58

have a lot of fluid in the sac, and if you tend

2:01

to image the patient at that point, you're going

2:03

to see that, and that's just normal physiology.

2:06

Then we've got the corpus luteum, which

2:09

develops after ovulation, and it's got

2:13

the function of maintaining the early

2:14

pregnancy, so it has a bit of a thick wall,

2:17

it's quite vascular, and that's the typical

2:19

appearance that we'll see on sonography.

2:22

The hemorrhagic cyst is usually quite

2:25

characteristic on ultrasound, and it tends

2:28

to have the appearance of a cobweb or a

2:31

lace-like configuration with lots of fibrin

2:34

strands, and it's got kind of an angular

2:37

clot that you can see sort of retracting,

2:41

and that's quite often seen in women.

2:42

Outlined here with very

2:44

angular and straight margins.

2:46

So that's what a hemorrhagic cyst looks like.

2:48

And most of those resolve within eight weeks.

2:51

The endometrioma is a cystic collection

2:54

of mixed blood products, and it is very

2:57

characteristically described as having

3:00

diffuse, low-level, internal echoes.

3:03

As you can see throughout this cyst here,

3:04

it's got this kind of ground glass appearance

3:07

and it does have through transmission.

3:10

And sometimes there is overlap between

3:12

a hemorrhagic cyst and an endometrioma.

3:15

And then finally here, we've got an

3:17

ovarian inclusion cyst, which happens

3:20

because of invagination of the cortical

3:22

surface of the ovary following ovulation.

3:25

And that results in a simple cyst

3:27

being formed, and usually those measure less

3:30

than 10 millimeters in size, and often we still

3:34

see them in the postmenopausal population.