How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Muneeb Ali Your Own Question
Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: OB GYN
Satisfied Customers: 3089
Experience:  MBBS, MD, MCCM.Currently working in Critical Care Medicine with 10 year experience in Medicine
22950887
Type Your OB GYN Question Here...
Dr. Muneeb Ali is online now
A new question is answered every 9 seconds

I had an Ultrasound done last year because was having pain

Customer Question

I had an Ultrasound done last year because was having pain in lower right side and then the pain returned now again. So today I had another Ultrasound done, I had a hysterectomy several years ago. Last year Ultrasound showed normal ovaries today Ultrasound showed complex cysts and fluid in right pelvis. My doctor also wanted them at same time of Ultrasound to check around appendix area. So he is concerned since today Ultrasound showed the complex cyst and fluid in right pelvis that wasn't there on last year Ultrasound. And I have noticed lately too I have been feeling more tired, trouble eating because so nauseated and diarrhea lately.So my doctor is going to put in a consult for me to GYN Doctor. What exactly are complex cysts and what do you think will be my required treatment recommended from the GYN Doctor do you think I will require any type of surgery or anything.
Submitted: 5 months ago.
Category: OB GYN
Expert:  Dr. Muneeb Ali replied 5 months ago.

Hi,

Im sorry to hear about your symptoms. Now complex cysts are actually small fluid filled cavities inside the ovaries which can have small septations (small pieces of fibrous tissue) criss crossing the cyst alongwith deposits of calcium inside them. While simple cysts are common and nothing to be worried about, complex cysts on the other hand are very concerning. This is because one of the causes of complex cysts can be ovarian cancer. Now while presence of complex cysts by themselves in NOT a confirmed diagnosis of cancer but it can indicate towards it. That is why further testing in the form of a CT scan of the abdomen and pelvis has to be done. Additional tests like CA-125 which isa tumor marker for ovarian cancer may be needed as well as other tumor markers.

Another cause can be endometriomas which are cysts which contain uterine tissue inside them and can give rise to symptoms which you are describing. Lastly this can also be due to BENIGN tumors of the ovaries which again can cause similar symptoms.

Now the treatment for most complex cysts if they are causing symptoms is removal of the cyst or the ovary itself, it depends on the CT scan as well as the other test which surgery they would have to perform. if it is a serious condition like tumors then extensive surgery MAY be needed to remove the ovary and other parts of the reproductive system. But at the moment surgery is TOO early, the first step wouldbe to determine what the actual cause here is. in endometriomas other forms of treatment like drugs can be tried as well but as i said a diagnosis is necessary here first with further testing.

Do you have any more questions?

Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Expert:  Dr. Muneeb Ali replied 5 months ago.

Remember this DOESNT mean that you have cancer, only that this does need further evaluation. In most cases this turns out to be a benign cause such as cystadenomas or a dermoid cyst containing other forms of tissue. if that is the case then removal of the cyst can be undertaken while trying to save the ovary. I mentioned cancer as that can be one of the causes HOWEVER in MOST cases that is not the case and the cause is usually benign. Infact only 0.3% of the cases with complex cysts turn out to be malignant tumors, the remaining are benign. So you dont have to worry just have to get evaluated.

Do you have any more questions?

Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Expert:  Dr. Muneeb Ali replied 5 months ago.

Also other forms of treatment of complex cysts can include use of birth control pills to try and shrink the size but again it depends on the type of the cyst and the underlying cause to see if birth control pills can be used.

Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Customer: replied 5 months ago.
What should I look out for if any certain types of symptoms that may develop that would indicate I go directly or right away to the Emergency Room if I haven't gotten a date with GYN Services or my appointment with GYN isn't that too soon upcoming.
Expert:  Dr. Muneeb Ali replied 5 months ago.

Well if you develop any of the following symptoms, IMMEDIATELY go to the ER,

1) Severe pain in the lower abdomen, either on the right or left side

2) Tenderness in the lower abdomen

3) Fever

4) Excessive Bleeding via the vagina

5) Swollen abdomen

6) Inability to pass stools or flatus for more than a day

7) Sudden onset of dizziness, lightheadedness, sweating or pallor which can indicate a ruptured cyst

In these scenarios go immediately to the ER, but in the meanwhile try to get an appointment with an OB/GYN within the next week, the earlier the better

Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Expert:  Dr. Muneeb Ali replied 5 months ago.

Would you to know anything else? If done for now, please remember to leave a positive rating as that is the only way we are compensated for our time spent helping you. You can continue to ask follow-up questions even after the rating.

Customer: replied 5 months ago.
This is what exactly it says about what was seen on my Ultrasound of ovaries. There may be minimal free fluid on right side of pelvis. There may be complex cystic processes in both adenxa. On finding right measures 3.4cm diameter and could contain low levels internal echoes and septation. On left side may relate to 2 adjacent cystic structures one measuring 2cm in diameter and other 1.4cm in diameter. Left ovary size is 3.9cm and right ovary size is 3.5cm.Do you know exactly what all this means and explain to me in best detail as possible.
Expert:  Dr. Muneeb Ali replied 5 months ago.

Actually i did explain the causes for this above, but ill tell you this again. There are three main reasons for complex cysts like these to occur. an ultrasound alone CANNOT differentiate between the causes and thats why a tissue diagnosis is needed. That means that either a biopsy would be done or a laproscopy would be done. This is a procedure in which a camera is inserted into your pelvis to look directly at the cysts and take a sample if needed.

The three possible causes here can be,

  • Dermoid cysts -These are the most common type and develop during the childbearing age. The cysts contain structures such as the teeth, hair, nail, bone, or sweat glands. It is a slow growing and rarely cancerous.
  • Cystadenomas - Cystadenomas are benign cysts that develop from cells that cover the outer layer of the ovary. There are two types, mucinous and serous cystadenoma. Mucinous adenoma contains a sticky, thick fluid. It can grow up to 30 cm (12 in) in diameter and weigh up to 100 pounds. It can fill up the abdomen and cause pressure on other structures such as the bladder and bowel. Serous cystadenoma contains a thin, watery fluid.
  • Endometriomas - Endometriomas are blood-filled cysts that arise from endometriosis. Endometriosis is a condition wherein the cells that are normally found inside the uterus grow outside the uterus, such as the ovaries, fallopian tubes, bladder, or bowel. Endometriomas care also called chocolate cysts. This is because the cells that grow in the ovaries bleed and become brown over time and result in a brown-colored cyst.

Now as i said previously this can also be due to ovarian cancer, a simple ultrasound cannot differentitate between these causes and you need additional tests. Test like CA-125 etc.

Now as far as your ultrasound goes,

There may be complex cystic processes in both adenxa.

This means that there are complex cysts in the tissue alongside where the uterus should be (yours has been removed, the adnexa refers to the structures which are near the uterus namely ovaries and fallopian tubes)

On finding right measures 3.4cm diameter and could contain low levels internal echoes and septation

This means that the right sided cyst is large (3.4 cm in size) and contains material which shows up as opaque on the ultrasound. Internal echoes may be due to blood clots, blood itself, other tissue materials like hair skin, thick pus inside the cyst. This only means that there is something opaque insid ethe ovary as to what it can be? that would be determined on a CT scan and laproscopy

. On left side may relate to 2 adjacent cystic structures one measuring 2cm in diameter and other 1.4cm in diameter.

This basically tells you that there are two cysts on the left side which are smaller than the ones on the right side

Left ovary size is 3.9cm and right ovary size is 3.5cm.

This just tells you the size of the ovaries , which are relatively larger than usual.

Now as to what this means, this means that you have complex cysts in the ovaries which need further tests like CT scans and laproscopy and blood tests like CA-125 to determine the cause. But considering that most complex cysts are benign and that the cysts are not very large and there are no other signsof cancer, i think these cysts are likely to be due to a benign cause.

Please remember to leave a positive rating as that is the only way that i am compensated for my time.