From the Guidelines
The patient's ultrasound findings are benign, and no immediate treatment is needed, but routine follow-up imaging in 3-6 months may be appropriate to monitor the ovarian cyst and dermoid. The ultrasound findings show a normal retroflexed uterus with an IUD properly positioned in the endometrial canal. The right ovary contains a 3.4 x 3.5 cm simple cyst along with smaller follicles, and a small 0.5 x 0.4 cm echogenic focus that likely represents a dermoid cyst. The patient has previously had her left ovary removed (oophorectomy). There is no free fluid in the cul-de-sac, which is reassuring as free fluid can sometimes indicate bleeding or other abnormalities. According to the O-RADS US risk stratification and management system 1, the simple ovarian cyst is likely physiologic (a normal part of ovarian function) and typically resolves on its own within 1-3 menstrual cycles. The small dermoid cyst (a type of benign tumor containing various tissue types) is very small and likely requires no intervention at this time, though it should be monitored during future ultrasounds to ensure it doesn't grow significantly. Some key points to consider in the management of adnexal masses include:
- The risk of malignancy in simple ovarian cysts is very low, regardless of size or menopausal status 1.
- Classic benign lesions, such as endometriomas, hemorrhagic cysts, and dermoids, have characteristic appearances on ultrasound and can be safely followed with yearly ultrasound if not excised 1.
- The O-RADS US risk stratification and management system provides a framework for categorizing adnexal lesions based on their risk of malignancy and guiding management decisions 1. Overall, the findings are benign with no evidence of acute abnormality, and routine follow-up imaging in 3-6 months may be appropriate to monitor the ovarian cyst and dermoid.
From the Research
Uterus and IUD Findings
- The uterus measures 7.3 x 2.9 x 4.2 cm, with a retroflexed uterus appearing normal in appearance 2, 3.
- The endometrial stripe is 0.2 cm, and the IUD is in standard position within the endometrial canal.
- Studies have shown that a properly positioned IUD is essential to prevent complications such as pelvic pain and abnormal bleeding 2, 4.
Ovarian Findings
- The right ovary measures 5.1 x 3.4 x 4.1 cm, with right ovarian blood flow present.
- A 3.4 x 3.5 cm simple right ovarian cyst and additional smaller follicles are noted.
- A 0.5 x 0.4 cm echogenic focus in the right ovary is possibly a dermoid.
- The patient is status post left oophorectomy, and no free fluid is present in the cul-de-sac.
Clinical Implications
- The presence of a simple ovarian cyst and echogenic focus may be associated with pelvic pain and abnormal bleeding 5.
- The patient's history of left oophorectomy and current IUD placement should be considered when evaluating her symptoms.
- Studies have emphasized the importance of proper IUD placement and management of pain associated with insertion 6.