Hemorrhagic Ovarian Cyst

Hemorrhagic Ovarian Cyst – Introduction

A hemorrhagic ovarian cyst is formed from an ovarian cyst or follicle that bleeds into itself, typically at the time of ovulation.

Synonym

Hemorrhagic corpus luteal cyst

ICD-10CM CODES
N83.20	Unspecified ovarian cyst

Epidemiology & Demographics

Predominant Sex & Age

Women of reproductive age.

Peak Incidence

Reproductive age. Hemorrhagic cysts are almost exclusively encountered in menstruating and ovulating adolescent females.

Risk Factors

Reproductive age, ovulation.

Physical Findings & Clinical Presentation

•Asymptomatic or acute onset of lower abdominal pain
•Rupture of this cyst may cause intraabdominal bleeding, peritoneal signs
•Can occur during pregnancy

Etiology

When an ovarian cyst or follicle ruptures, bleeding into the ruptured cyst wall causes irritation and pain.

Differential Diagnosis

•Ectopic pregnancy
•Endometrioma
•Tubo-ovarian abscess
•Neoplasm
•Dermoid cyst
•Ovarian torsion
•Appendicitis
•Pelvic inflammatory disease
•Diverticulitis
•Urolithiasis

Workup

Laboratory Tests

CBC, urinalysis

Serum human chorionic gonadotropin (hCG) or urine pregnancy test

Imaging Studies

•Transvaginal ultrasound (US): The sonographic appearance of hemorrhagic cysts is highly variable. Most hemorrhagic cysts have a thin outer wall, demonstrate posterior acoustic through-transmission, and can be variable in size but often measure 3 to 3.5 cm in diameter. Fine, reticular septations resembling a fishnet pattern are a common finding on US. ¹ ^, 2
•Pelvic MRI.

Treatment

Acute General Rx

•Observation, pain management, supportive care ³
1Ibuprofen, Tylenol, heating pads
•Surgical intervention is rarely needed

Disposition

•If stable can be discharged home
•If vitals unstable or if concern for ongoing bleeding either through clinical worsening or decreasing hemoglobin/hematocrit, may require diagnostic laparoscopy

Referral

•General gynecology
- 1.Symptomatic cysts greater than 6 cm in premenopausal patients
•Gynecology oncologists
- 1.Image findings concerning for cancer ³

Pearls & Considerations

•If the diagnosis of hemorrhagic cyst is uncertain, a 6-wk follow-up US can be obtained.
•Hemorrhagic cysts change throughout the menstrual cycle and typically will resolve or decrease in size at follow-up.

Prevention

•Hormonal contraceptives can decrease ovarian cyst formation. ⁴

References

1.Abbas A.M., et al.: Hemorrhagic ovarian cysts: clinical and sonographic correlation with the management options . Middle East Fertil Soc J 2016; 21 (1): pp. 41-45.

2.Jain K.A., et al.: Sonographic spectrum of hemorrhagic ovarian cysts . J Ultrasound Med 2002; 21 (8): pp. 879-886.

3.Ross E.K., Kebria M.: Incidental ovarian cysts: when to reassure, when to reassess, when to refer . Cleve Clin J Med 2013; 80 (8): pp. 503-514.

4.Grimes D.A., et al.: Oral contraceptives for functional ovarian cysts . Cochrane Database Syst Rev 2014; 4: pp. CD006134.