What does a degenerating cyst on the left ovary as seen on a pelvic ultrasound indicate?

Understanding a Degenerating Cyst on the Left Ovary on Pelvic Ultrasound

A degenerating cyst on the left ovary seen on pelvic ultrasound most commonly represents a hemorrhagic functional cyst that is in the process of resolving naturally. These cysts are benign and typically resolve spontaneously without intervention, particularly in premenopausal women. 1

Characteristics of Degenerating Cysts

• Degenerating cysts often show specific sonographic features including:

  • Spider web-appearing or retracting clot within the cyst 1
  • Peripheral vascularity around the cyst wall 1
  • Hypoechoic internal debris or focal intracystic echogenicity 1
  • Sometimes a mixture of solid and cystic components as the cyst resolves 2

• The internal appearance may evolve through different patterns during resolution:

  • Initially appearing as hyperechoic/hypoechoic solid type
  • Developing a reticular or sponge-like pattern
  • Showing a mixture of solid and cystic components
  • Eventually becoming completely cystic before disappearing 2

Clinical Significance

• Most cysts in premenopausal women are functional in nature and will resolve spontaneously 1
• The presence of septum-like or thread-like echoes within the cyst is characteristic of hemorrhagic degenerating cysts 2
• Follow-up ultrasound typically shows either:
  • Complete resolution of the cyst (46.3% of cases) 3
  • Persistence without change in size or characteristics (43.9% of cases) 3
  • Rarely, transformation to complex cysts (7.9%) 3

Management Approach

• For simple degenerating cysts with typical features:

  • Follow-up ultrasound is recommended to document resolution 1
  • Surgery is generally not necessary unless symptoms are severe or persistent 4

• Features that would warrant closer monitoring include:

  • Thick or irregular septations
  • Mural nodules
  • Solid or papillary components
  • Diameter greater than 5 cm 1

Important Considerations

• Transvaginal ultrasound is the essential imaging modality for proper characterization of ovarian cysts 1

• Color or power Doppler should be included in the examination to differentiate true solid components from debris and to assess vascularity patterns 1

• In cases where ultrasound findings are equivocal, MRI may be used as a problem-solving modality 1

• Common pitfalls to avoid:

  • Mistaking a degenerating cyst for a solid ovarian mass 1
  • Confusing a hemorrhagic cyst with an endometrioma (both can have internal echoes) 1
  • Unnecessary surgical intervention for a cyst that would resolve spontaneously 4