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Ovarian/Adnexal Cystic Lesion–Ultrasound (SRU)

  Ovarian and Adnexal Cyst–Ultrasound

This guidance applies to asymptomatic nonpregnancy women.


Please select the type of cystic lesion:

Simple cyst         




Corpus luteum            



Hemorrhagic cyst        









Peritoneal inclusion cyst             



Probably benign cyst   


Indeterminate cyst         


Cyst worrisome for malignancy       


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Simple Cyst: Includes ovarian and paraovarian cyst. Round or oval anechoic fluid collection with smooth thin walls, no solid component or septation and no internal flow.


Corpus luteum: A cyst with diffusely thick walls(2-4 mm thick) and crenulated inner margins. Measures <3 cm in maximal diameter. With internal echoes and a ring of vascularity at the periphery at color Doppler US.

Hemorrhagic cyst: Complex cyst with reticular pattern of internal echoes (fishnet, cobweb, spiderweb or lacy appearance). Nonvascular solid appearing area with concave margins(retraction clot). No internal flow (can have circumferential flow in the wall).

Endometrioma: Homogeneous low level (ground glass) internal echoes. No solid component, wall nodule or internal flow. +/- Tiny echogenic foci in wall/multilocularity.

Dermoid: Focal or diffuse hyperechoic components. Hyperechoic lines and dots. Areas of acoustic shadowing. No internal flow. Floating spherical structures.

Hydrosalpinx: Tubular shaped cystic mass. +/- Short round projections(beads on a string). +/- Waist sign(i.e. indentations on opposite sides. +/- Seen separate from the ovary.

Peritoneal inclusion cyst: Follow the contour of adjacent pelvic organs. Ovary at the edge of the mass or suspended within the mass. +/- Septations(can have flow in septations).


Probably benign cyst: Findings suggestive of, but not classic for, hemorrhagic cyst, endometrioma or dermoid.

Indeterminate cyst: Multiple thin septations (<3 mm). Non-hyperechoic nodule without flow.

Cyst worrisome for malignancy: thick (>=3 mm) irregular septations. Solid elements with flow. Focal areas of wall thickening(>=3 mm).