parovarian cyst

What are Paraovarian Cysts?

Paraovarian cysts, also known as paratubal cysts or hydatid cysts of Morgagni, are noncancerous, fluid-filled sacs that form near the ovaries and are closely associated with the fallopian tubes. These cysts are often small, ranging from a few millimeters to several centimeters in size.

Causes and Risk Factors

The exact cause of paraovarian cysts is not fully understood, but they are thought to develop from tissues left over from fetal development. They are usually benign growths that do not cause noticeable symptoms in many cases.

Characteristics

• Paraovarian cysts are fluid-filled sacs that form adjacent to the ovary, within the broad ligament of the uterus.
• Unlike ovarian cysts, which develop directly on the ovaries, paraovarian cysts are separate entities that arise from the tissues surrounding the ovaries.
• These cysts can occur on either side of the pelvis.

Key Facts

• Paraovarian cysts account for ~10-20% of adnexal masses [5].
• They are remnants of Wolffian duct in the mesosalpinx that do not arise from the ovary [5].
• The mean diameter of paraovarian cysts is 40 mm, with a range of 15-120 mm [13].

References

[1] - Paraovarian cysts or paratubal cysts are epithelium-lined fluid-filled cysts in the adnexa adjacent to the fallopian tube and ovary. The terms are used interchangeably, and depend on the location of the cyst.

[2] - Pathophysiology of paraovarian cysts is not fully understood, but they are thought to develop from tissues left over from fetal development.

[5] - Paraovarian cysts account for ~10-20% of adnexal masses.

[13] - Key facts about paraovarian cysts, including their characteristics and imaging features.

Common Signs and Symptoms of Parovarian Cysts

Parovarian cysts, also known as paraovarian cysts or hydatid cysts of Morgagni, are fluid-filled masses that occur near the ovaries or fallopian tubes. While most parovarian cysts do not cause symptoms, some may present with the following signs and symptoms:

• Pressure Symptoms: Large parovarian cysts can put pressure on internal organs, including the uterus, kidney, bladder, and bowel, leading to:
  • Hydro-nephrosis (kidney swelling caused by excess urine buildup) [2]
  • Uterine bleeding
  • Painful intercourse [2]
• Pelvic Pain: A large parovarian cyst can cause pelvic pain that may come and go, ranging from a dull ache to a sharp pain in the area below the belly button toward one side [3].
• Signs of Shock: In rare cases, a ruptured or twisted parovarian cyst can lead to signs of shock, including:
  • Cold, clammy skin
  • Rapid breathing
  • Lightheadedness or weakness [3]
• No Symptoms: Most parovarian cysts are asymptomatic and go away on their own without any noticeable symptoms.

It's essential to note that complications from parovarian cysts can be serious and require immediate medical attention. If you experience sudden, sharp pain in your abdomen, pain radiating from your low back, or intense pain that makes you feel sick to your stomach, seek help right away [9].

References: [1] - Search result 6 [2] - Search result 2 [3] - Search result 3 [9] - Search result 9

Diagnostic Tests for Parovarian Cysts

Parovarian cysts, also known as paraovarian or paratubal cysts, are fluid-filled sacs that form near the ovaries or fallopian tubes. Diagnosing these cysts can be a bit challenging, but various tests and imaging studies can help confirm their presence.

Imaging Studies

• Pelvic Ultrasound: This is usually the first imaging test used to diagnose parovarian cysts. A pelvic ultrasound uses sound waves to create images of the pelvic organs, including the ovaries and fallopian tubes. It can detect cysts on the ovaries or near the fallopian tubes.
• Computed Tomography (CT) Scan: CT scans use X-rays and computer technology to create detailed images of the internal structures of the body. They may be used to confirm the presence of a parovarian cyst, especially if it's large or complex.
• Magnetic Resonance Imaging (MRI): MRI is another imaging test that uses magnetic fields and radio waves to create detailed images of the internal structures of the body. It can provide more detailed information about the size, location, and characteristics of a parovarian cyst.

Other Diagnostic Tests

• Physical Examination: A physical examination by a healthcare provider may reveal a lump or mass near the ovaries or fallopian tubes.
• Laboratory Tests: Laboratory tests, such as blood tests, may be used to rule out other conditions that may cause similar symptoms. However, these tests are not typically used to diagnose parovarian cysts.

Key Points

• Imaging studies, particularly pelvic ultrasound, are crucial in confirming the presence of a parovarian cyst.
• A combination of physical examination and imaging studies can help diagnose parovarian cysts.
• Laboratory tests may be used to rule out other conditions that may cause similar symptoms.

References:

[1] (8) Computed tomography (CT) or magnetic resonance imaging (MRI). These advanced radiology options provide even clearer images of the pelvic region, which can help confirm the presence of a parovarian cyst. [2] (10) A cyst on your ovary can be found during a pelvic exam or on an imaging test, such as a pelvic ultrasound. Depending on the size of the cyst and whether it's filled with fluid or solid, your health care provider likely will recommend tests to determine its type and whether you need treatment. [3] (13) Then, they may use the following tests to diagnose an ovarian cyst: A pelvic exam. Your provider will feel inside your pelvis for any lumps or changes. Ultrasound. This imaging procedure uses sound waves to create images of your pelvic organs. It can detect cysts on your ovaries, including their locations and whether they’re primarily fluid ... [4] (14) Cysts that are characterized as complex adnexal masses or as persistent, thin-walled cysts should be evaluated for possible ovarian cancer.

Differential Diagnosis of Parovarian Cyst

Parovarian cysts, also known as paraovarian or paratubal cysts, are benign intraperitoneal mesothelial cysts that can be challenging to diagnose. The differential diagnosis for parovarian cysts includes:

• True ovarian cyst: A true ovarian cyst is a fluid-filled sac within the ovary itself, which can mimic the appearance of a parovarian cyst on imaging studies.
• Hydrosalpinx: Hydrosalpinx refers to a fluid-filled fallopian tube that can be mistaken for an ovarian or parovarian cyst.
• Peritoneal inclusion cyst: A peritoneal inclusion cyst is a rare type of cyst that forms in the peritoneum, which can be confused with a parovarian cyst.
• Ovarian cystic neoplasm: An ovarian cystic neoplasm is a type of tumor that can have a solid component and may be mistaken for a parovarian cyst.

Key Diagnostic Features

To accurately diagnose a parovarian cyst, it's essential to identify the following features:

• Separation from the ovary: A parovarian cyst should be visualized as separate from the ovary itself.
• Normal ipsilateral ovary: The presence of a normal ipsilateral ovary can help rule out an ovarian cyst.
• Beak sign: In some cases, a "beak sign" may be present, which is a characteristic feature of parovarian cysts.

Clinical Considerations

Parovarian cysts are relatively rare, accounting for 10-20% of all adnexal masses. They can be asymptomatic or present with abdominal pain, and in some cases, they can be complicated by torsion, growth, or malignancy.

Diagnostic Checklist

When evaluating a patient suspected to have a parovarian cyst, it's essential to consider the following:

• Imaging studies: Imaging studies such as ultrasound, CT, or MRI may help identify the cyst and its relationship to the ovary.
• Clinical history: A thorough clinical history should be taken to rule out other potential causes of abdominal pain or masses.
• Surgical consultation: In some cases, surgical consultation may be necessary to confirm the diagnosis and plan appropriate management.

References:

• Barloon et al. (2000) [12]
• Katre et al. (2010) [16]
• Top Differential Diagnoses (2024) [10]