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Peritoneal Inclusion Cyst


KEY FACTS

Terminology

  • Loculated fluid trapped within peritoneal adhesions, typically surrounding ovary

Imaging

  • Most often in pelvis (can rarely occur elsewhere)

  • Ultrasound

    • Loculated cystic mass with "spiderweb" pattern due to peritoneal adhesions reflecting from ovary

    • Fine septations throughout collection

    • Normal ovary at center or lateral margin of cyst

    • No solid mural or septal nodule to suggest malignancy

    • Usually anechoic fluid, but can have internal echoes due to hemorrhagic or proteinaceous contents

  • MR

    • Cystic mass with serous fluid (low signal on T1, high signal on T2) and thin internal septations

    • Margins of cyst outlined by other structures in pelvis (pelvic side walls, uterus, ovaries, loops of bowel)

    • Morphologically normal ovary at center of cyst

Top Differential Diagnoses

  • Ovarian cancer

  • Ovarian cyst or follicle

  • Paraovarian cyst

  • Hydrosalpinx

  • Lymphocele

  • Lymphangioma or other congenital cyst

Pathology

  • Most often in women with prior pelvic surgery or inflammatory disorders (endometriosis, pelvic inflammatory disease, inflammatory bowel disease)

Clinical Issues

  • Primarily seen in women of reproductive age

  • Can rarely occur in men or post-menopausal women

Diagnostic Checklist

  • Cystic ovarian neoplasm or malignancy if thick septations, solid component/mural nodularity, or large ascites

Transvaginal US in a patient with history of multiple prior surgeries for Crohn's disease shows an anechoic cyst
with internal septations
enveloping a normal-appearing ovary
, a classic appearance for peritoneal inclusion cyst.

Axial CECT in a patient who had undergone colectomy with creation of a Hartmann pouch
shows a loculated, thin-walled pelvic fluid collection
partially surrounding the left ovary
, characteristic features of a peritoneal inclusion cyst.

Longitudinal endovaginal US in a woman with 2-year history of pelvic pain and prior surgery for endometriosis demonstrates a complex fluid collection
with internal septations
surrounding the left ovary
, which contains normal follicles. Surgery revealed a peritoneal inclusion cyst and normal ovary.

Transvaginal US shows the right ovary
enveloped by an anechoic fluid collection
. A normal follicle is present within the ovary
. This is a typical appearance of a peritoneal inclusion cyst.

TERMINOLOGY

Synonyms

  • Benign encysted fluid, benign multicystic peritoneal mesothelioma, inflammatory cysts of peritoneum, postoperative peritoneal cysts, peritoneal pseudocysts, inflammatory cysts of pelvis

Definitions

  • Loculated fluid trapped within peritoneal adhesions, typically surrounding ovary

IMAGING

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