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Transvaginal ultrasound showed complex cyst causing mild pain. Looking for suggestion

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Practicing since : 2007
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I was told I had a complex cyst by transvaginal ultrasound in July (that was previously a simple cyst in April) by my regular gynecologist. I was sent to a gynecologist oncologist and had a CAT scan (abdominal and pelvic) and the report said it was a simple cyst. Then 3 weeks later on 9/27/12, I had a second opinion from a different gynecologist oncologist via another transvaginal ultrasound. I was again told it was a simple cyst. I've asked this question before on here but would just like to ask again just to get a couple opinions. I've attached several photos of the 9/27/12 ultrasound and the ultrasound report as well. To me this photo looks like the cyst has a septation in it off to the right side. If this is the case, I thought this would be called a complex cyst but I have been told now twice by two different oncologist gynecologists that it's a simple cyst (again based on the CAT scan and 3 weeks later, the ultrasound). The report does say there is adjacent fluid next to the cyst so perhaps what I'm thinking is a septation is the wall of the cyst and then the fluid next to it.
The cyst causes me mild pain but sometimes I have a week or longer where I feel no pain whatsoever.
Mon, 31 Dec 2012 in X-ray, Lab tests and Scans
Answered by Dr. Ganesh Sanap 20 hours later

I have seen all photographs. Definitely you are right, it looks like a septations within cysts. Now i will explain why it looks so. Firstly cyst is quite large. Ultrasound works on principle of sound wave. Whenever there is such a large cystic lesion there occurs an artefact known as REVEBERATION artefact, which gives such shadows. It is the duty of sonologist to identify artefact from sepatations or debris. Your doctor had done correct scan. Details of the physics of same thing is quite difficult to explain.

On CAT, due to surrounding fluid it may look like a septation. Normally CAT is not sensitive to identify XXXXXXX septations of ovary.

As you had history of left ovarian pathology, just follow protocol of routine follow up.

Regarding the pain due to cyst, consult your gynecologist he/she advise you proper treatment.

Hope i have answered your query. Follow up question are welcome.
Above answer was peer-reviewed by
Follow-up: Transvaginal ultrasound showed complex cyst causing mild pain. Looking for suggestion 33 minutes later
Thank you for your reply. Just to make sure I understand, I know I've only posted some of the photos. I bieve there were actually a total of 67 different photos. Are you saying you agree that the photos I did post are actually the wall of the cyst versus a septation?
Also, I was told the cyst looks unalarming/just like a typical fluid filled cyst. Do you agree with this?
Answered by Dr. Ganesh Sanap 1 hour later

Welcome back,

It does not exactly look like septations; but person who has been doing regular sonography can differentiate between these two entities.

Your cyst is not alarming in the sense of content of size; but I do agree it is large. In such situations regular follow up or cystectomy (removal of cyst) is necessary. However if there are mural nodule (solid part in the cyst and not septation), then it is alarming thing.

Hope you have got your query answered. Let me know if you have any other concerns.

Above answer was peer-reviewed by
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