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Ovarian Cyst
Everything in the library about ovarian cyst — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Case-Based Learning
2 items
Ovarian Salvage (Torsion & Benign Tumor): Practice Gap discussion at Update...
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss ovarian salvage, focusing on low sensitivity of ultrasound, pursuing laparosc
video14:07 · Sep 2018
Ovarian Torsion Rapid Fire: Update Course 2015
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Dr. Andrea Hayes Jordan discusses ovarian torsion, including timing for surgery, ovarian preservation, and ovarian fixation.
video12:46 · Jan 2019
In-Depth Reviews
1 item
Ovarian Cysts with Dr. Roshni Dasgupta
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The differential diagnosis for an ovarian cyst is broad. Join Dr. Roshni Dasgupta for tips and tricks for the work up and management of Ovarian Cysts in pediatric patients.
video · Aug 2022
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Ovarian Salvage (Torsion & Benign Tumor): Practice Gap discussion at Update...
Ultrasound is a horrible test for torsion according to a pediatric radiologist who was president of the Pediatric Radiology Society
host_summary0:46 ↗
Ultrasound is good at identifying the mass and enlarged ovary but should never provide comfort that torsion is not present
clinical1:07 ↗
The presence or absence of flow to the ovary on ultrasound should not provide comfort that the patient does not have torsion
clinical1:07 ↗
Ultrasound for ovarian torsion is a coin flip in terms of whether vascular flow is seen
host_summaryTodd Ponsky1:29 ↗
Black, apparently dead ovaries should be left in place after detorsion
host_summary2:35 ↗
A study is underway to improve diagnostic accuracy for torsion and create a scoring system to decrease negative laparoscopies
clinical3:00 ↗
In 2018, there is no better diagnostic test for torsion than clinical suspicion leading to laparoscopy
clinical3:00 ↗
When an ovary is malignant, removal is appropriate
host_summaryTodd Ponsky5:01 ↗
Clinical assessment at the time of operation is unreliable in determining the presence of viable ovarian cortical tissue
host_summaryTodd Ponsky6:18 ↗
Serial ultrasounds after leaving black ovaries in place have shown follicles, indicating functional ovarian tissue was present
clinicalTodd Ponsky6:18 ↗
For a torsed ovary with a dermoid cyst, the strategy is to detorse, leave the mass in situ, follow with ultrasound to see if the ovary survives, and return to remove the cyst if it does
clinical7:29 ↗
Ultrasound follow-up over approximately 6 weeks is used to determine if a detorsed ovary survives
clinical7:29 ↗
Kate Dean has funding from the Thrasher Foundation through the Midwest Pediatric Surgeon Consortium to study an algorithm using tumor markers, size, and radiologic confirmation to determine if ovarian masses are benign
host_summaryTodd Ponsky9:10 ↗
Masses in association with ovarian torsion occur in approximately 20% of cases
epidemiological11:02 ↗
The risk of malignancy in ovarian masses associated with torsion is very low
epidemiological11:02 ↗
The strategy for torsion with a mass is to detorse the ovary, and if the mass can be dealt with at that time with ovarian-sparing surgery, that is acceptable; otherwise close and return after monitoring
clinical11:02 ↗
There is no urgency in deciding about mass removal; tumor markers can be obtained, the case can be taken to tumor board, and the decision can be made in a non-emergent fashion
clinicalTodd Ponsky11:49 ↗
Laparoscopic ovarian-sparing mass resection has technical challenges; a Pfannenstiel incision may be easier for palpation and dissection
clinical12:12 ↗
In ovarian torsion, detorsion should be addressed first, and the mass is a separate issue to be dealt with using ovarian-sparing surgery
clinical12:49 ↗
If a Pfannenstiel incision is needed to accomplish ovarian-sparing surgery, that is preferable to oophorectomy
clinical12:49 ↗
Ovarian Torsion Rapid Fire: Update Course 2015
Ovarian torsion is most common in teenage girls and is being seen as an urgent rather than emergent situation when aiming to preserve the ovary.
clinicalAndrea0:01 ↗
Many black-colored ovaries actually have viable follicles in them, and ovarian preservation should be the goal.
clinicalAndrea1:40 ↗
In oophorectomy specimens removed for torsion where the surgeon believed the ovary was dead, 76% had normal ovarian tissue, only 13% had no ovarian tissue, and only 11% were completely necrotic.
epidemiologicalAndrea3:20 ↗
Microscopically, ovarian tissue looks very different than it does in the gross setting when a surgeon is looking at the ovary.
clinicalAndrea4:00 ↗
Pain is the most commonly reported consequence of oophoropexy, which is usually short-lived and resolves in about a week.
clinicalAndrea4:20 ↗
The ability to preserve ovarian function is related to age; in pediatric patients, surgeons should be aggressive about preserving the ovary, but in older adults there are fewer active follicles.
clinicalAndrea4:40 ↗
The recommendation is for detorsion without complete oophorectomy.
guidelineAndrea5:20 ↗
Ultrasound sensitivity and specificity for blood flow in ovarian torsion is in the 50-60% range.
epidemiologicalAndrea8:16 ↗
If the child is in a lot of pain, surgery needs to be done right away; ultrasound blood flow findings should not be relied upon.
opinionAndrea8:30 ↗
Pediatric radiologists, including presidents of their national organization, have stated that ultrasound does not help in the setting of suspected ovarian torsion.
host_summary7:59 ↗
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