Pictures, Causes, Types, Treatments, and Prevention

A cyst is a small pocket of tissue filled with fluid, pus, or other substances. Cyst maybe caused by injury, infection, or other issues. They’re usually benign but may need treatment if complications arise.

A cyst is a sac-like pocket of membranous tissue that contains fluid, air, or other substances. Cysts can grow almost anywhere in your body or under your skin.

There are many types of cysts. Most cysts are benign or noncancerous.

Whether a cyst needs treatment depends on a number of factors, including:

• the type of cyst
• the location of the cyst
• whether the cyst is causing pain or discomfort
• whether the cyst is inflamed or infected

If you’re not sure if you have a skin condition, you can take a picture and send it to an online dermatologist.

Cysts can vary in appearance depending on their type and location. Here are 11 types of cysts.

Epidermoid cyst

Epidermoid cysts are small, benign bumps filled with keratin. Kertain is a protein that’s essential in forming your skin, hair, and nails. Epidermoid cysts occur when something blocks hair follicles, and skin cells build up beneath this blockage.

These cysts can look like a skin-colored, tan, or yellowish bump filled with thick material. They typically occur on your face, neck, or torso, but can occur across your body.

In rare cases, epidermoid cysts can be caused by an inherited condition called Gardner syndrome.

Read more about epidermoid cysts.

Sebaceous cyst

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Sebaceous cysts are filled with sebum and are less common than epidermoid cysts. They often form within sebaceous glands, which are part of your skin and hair follicles. Sebaceous glands make oil for your skin and hair.

These cysts most commonly occur on your face, neck, or torso, and are often the result of damage to sebaceous glands.

Read more about sebaceous cysts.

Breast cyst

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Benign cysts can develop when fluid collects near your breast glands. They can cause pain or tenderness in the affected area.

While breast cysts are noncancerous, there are many possible other more serious causes for a lump in your breast. It’s important to be familiar with how your breasts typically feel so you’re aware of changes. This way, you’re more likely to notice changes right away.

You should try to make an appointment to see a healthcare professional if:

• you discover a new lump
• an area of your breast is noticeably different than the rest
• a lump changes or grows larger
• you notice unexpected discharge from the nipple
• you have an inverted nipple, and it wasn’t always inverted

Read more about breast lumps.

Ganglion cyst

A ganglion cyst is a round, gel-filled lump of tissue that usually appears along tendons or joints, especially in the hands, wrists, ankles, and feet. Fluid accumulation can occur due to injury, trauma, or overuse, but often the cause is unknown.

A ganglion cyst is common, harmless, and doesn’t cause pain or difficulties unless it grows and puts pressure on other structures.

Read more about ganglion cysts.

Pilonidal cyst

A pilonidal cyst is a common skin condition that forms in the cleft at the top of your buttocks. It consists of a small hole or tunnel in the skin that may become infected and fill with fluid or pus and it typically occurs after puberty.

Changing hormones, hair growth, and friction from clothes or from spending a long time sitting may all cause a pilonidal cyst.

Symptoms of an infection include:

• pain when sitting or standing
• discolored or sore skin around the area
• pus or blood draining from the abscess, causing a foul odor
• swelling of the cyst
• hair protruding from the lesion

Read more about pilonidal cysts.

Ovarian cyst

Ovarian cysts often form when the follicle that normally releases an egg doesn’t open. This causes fluid to build up and form a cyst.

Another common type of ovarian cyst occurs after the follicle releases the egg and improperly recloses and collects fluid.

Ovarian cysts occur most often in those of menstrual age and are typically first found during pelvic exams.

Ovarian cysts are associated with an increased risk of cancer when they occur after menopause.

Read more about ovarian cysts.

Baker (popliteal) cyst

A Baker cyst is a swollen, fluid-filled sac at the back of your knee.

Causes of Baker cysts include conditions or occurrences that affect the joints such as arthritis, inflammation from repetitive stress, or a cartilage injury. Baker cysts can cause inflammation and pain and lower range of motion in your knee.

Physical therapy, fluid draining, and medication can all be used to help treat a Baker cyst.

Read more about Baker cysts.

Pilar cyst

A pilar cyst is a noncancerous, skin-colored, round bump that develops under the surface of your skin. They usually affect the skin on the scalp and results from protein buildup in a hair follicle.

They’re not cancerous, but they can grow to a size that can be uncomfortable.

Read more about pilar cysts.

Mucous cyst

A mucous cyst is a fluid-filled lump that forms on your lip or around your mouth when the salivary glands become plugged with mucus. The most common causes of mucous cysts include:

• lip or cheek biting
• lip piercings
• rupture of the salivary gland
• improper dental hygiene

Mucous cysts will often go away on their own. But if you have recurring or frequent mucous cysts, you may need medical treatment.

Read more about mucous cysts.

Branchial cleft cyst

Photography by BigBill58/Wikimedia Commons

A branchial cleft cyst is a type of developmental irregularity in which a lump develops on one or both sides of your neck or below your collarbone. It occurs during embryonic development when tissues in your neck and collarbone, or branchial cleft, develop differently.

In most cases, a branchial cleft cyst isn’t dangerous. But it may cause skin irritation, skin infection, or — in very rare adult cases — cancer.

Read more about branchial cleft cysts.

Perineural (Tarlov) cyst

A perineural cyst is a fluid-filled sac that forms on the spine.

Causes are unknown, but it may result from back trauma, including falls, injuries, and heavy exertion.

A perineural cyst can cause pain in your lower back, buttocks, or legs, but this is rare. If you do have symptoms, draining the fluid can help to relieve them.

Read more about perineural cysts.

A pseudocyst shares some of the characteristics of a cyst, but the bump doesn’t have its own lining. Here are three types of pseudocysts.

Folliculitis (ingrown hair cyst)

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Folliculitis is an infection of hair follicles. It’s often the result of a fungal or bacterial infection and can often resemble acne.

These pseudocysts are often seen in people who use hair removal methods like shaving or waxing. Ingrown hair cysts are an example of folliculitis. While ingrown hair cysts are possible, if you have bumps that appear near ingrown hairs, there’s a good chance that they’re actually razor bumps instead.

Razor bumps are also known as pseudofolliculitis barbae, which is a type of pseudofolliculitis. Unlike folliculitis, pseudofolliculitis isn’t usually infectious.

Read more about ingrown hair cysts.

Chalazion

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A chalazion is a small, usually painless lump on your eyelids that occurs when the duct of the meibomian gland, an oil gland, is blocked.

These pseudocysts can cause tenderness, blurred vision, and painful swelling. If they get too big, they can cause vision difficulties.

Read more about chalazia.

Cystic acne

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Cystic acne results from a combination of bacteria, oil, and dead skin clogging the pores. It’s the most severe type of acne, but it usually improves with age.

Cystic acne can look like large, pus-filled boils on the skin. It can also be painful to the touch. If these boils rupture, they can cause scarring.

Cystic acne most commonly occurs on your face, chest, neck, back, and arms.

If you believe you may have cystic acne, a dermatologist can prescribe medications to help treat it.

Learn more about acne treatments here.

A cyst can appear as a bump on your skin. These can vary in size from small, pimple-sized lumps to much larger, more obvious growths.

Some cysts grow deep inside your body where you can’t feel them. But they may cause or be related to other symptoms.

For example, ovarian cysts, such as those that result from polycystic ovary syndrome, may cause difficulties with ovarian and reproductive function. Polycystic kidney disease, which causes cysts to form in the kidney, can adversely affect kidney function.

Most cysts aren’t painful. They usually don’t cause difficulties unless they’re:

• infected
• very large
• impinging on a nerve or blood vessel
• growing in a sensitive area
• affecting the function of an organ

Cysts and pseudocysts form for different reasons. They can be caused by:

• infections
• inherited diseases
• genetics
• chronic inflammation
• blockages in ducts

The exact cause depends on the type of cyst or pseudocyst.

You should try to schedule an appointment with a healthcare professional if your cyst becomes painful, or increasingly inflamed. This could be a symptom of a rupture or an infection.

They should check your cyst even if it isn’t causing any pain or other difficulties. Differences in these growths can be a symptom of cancer. A healthcare professional may want to remove a tissue sample for testing.

You should never try to squeeze or pop a cyst or pseudocyst yourself, as this can lead to infection.

In some cases, they improve on their own. Putting a warm compress on a cyst can speed up the healing process by helping it drain.

In other cases, medical care is required.

Medical care

Common methods of medical treatment for cysts include a healthcare professional:

• using a needle to drain fluids and other matter from the cyst
• giving you medications, such as a corticosteroid injection, to lower inflammation in the cyst
• performing a surgical removal of the cyst, which may be done if draining doesn’t work or if you have an internal cyst that’s hard to reach and requires treatment

If you’re concerned about your cyst and don’t have an established relationship with a healthcare professional, you can view doctors in your area through the Healthline FindCare tool.

Benign cysts and pseudocysts usually don’t cause long-term difficulties. Sometimes they even go away on their own.

Cysts can refill after being drained. If you have a cyst that continues to refill, you may want to consider having it surgically removed.

If you have cancerous cysts, a healthcare professional will discuss treatment with you. The outlook will vary depending on the type of cancer involved.

Most types of cysts and pseudocysts can’t be prevented, but there are a few exceptions. Those prone to ovarian cysts may be able to prevent new cysts from forming by using hormonal contraceptives.

You can prevent pilonidal cysts from forming by keeping the skin in the affected area clean and dry. Getting up every so often instead of sitting for a long time can also help prevent these cysts.

Cleaning your eyelid near the eyelash line with a gentle cleanser can help keep the oil ducts from becoming blocked. This may help prevent chalazia.

Read this article in Spanish.

Types, pictures, symptoms, causes, and treatment

Cysts are closed capsule or sac-like structures, typically containing a liquid, semisolid, or gaseous material, much like a blister. There are many types, such as acne cysts and ganglion cysts, and kidney cysts.

Cysts vary in size from microscopic to very large. Very large cysts can displace internal organs.

A cyst is not a normal part of the tissue where it occurs. It has a distinct membrane and is separate from nearby tissue. The outer, or capsular, portion of a cyst is known as the cyst wall.

If the sac has filled with pus, the cyst is infected and will turn into what doctors call an abscess.

They are usually benign, but some cysts can be cancerous or precancerous.

This article looks at the different types of cysts, their causes and symptoms, and some treatment options.

Some common types of cyst include:

Acne cysts

Cystic acne, or nodulocystic acne, is a severe type of acne in which the skin’s pores become blocked, leading to infection and inflammation.

Arachnoid cysts

The National Institute of Neurological Disorders and Stroke notes that arachnoid cysts develop between the arachnoid membrane and the brain or spinal cord. These cysts contain cerebrospinal fluid.

Arachnoid cysts may affect newborn babies. Doctors call these primary arachnoid cysts.

The arachnoid membrane covers the brain. During fetal development, it doubles up or splits to form an abnormal pocket of cerebrospinal fluid. In some cases, a doctor may need to drain the cyst.

Secondary arachnoid cysts develop as a result of head injury, tumors, or meningitis.

Baker’s cysts

Baker’s cysts are also known as popliteal cysts.

Some do not cause any symptoms. However, a person with a Baker’s cyst can experience:

• knee pain
• a lump behind the knee
• a feeling of fullness behind the knee
• swelling in the knee and lower leg
• stiffness or tightness located at the back of the knee

Baker’s cysts usually develop due to a problem with the knee joint, such as arthritis or a cartilage tear.

Bartholin’s cysts

Bartholin’s cysts can occur if the ducts of the Bartholin gland, which are inside the vagina, become blocked.

A doctor may recommend surgery or prescription antibiotics as treatment.

Breast cysts

Breast cysts are common and may be painful.

In females, these cysts can develop or change in size throughout the menstrual cycle, and they often disappear on their own. However, a doctor can drain the fluid if they are causing discomfort.

According to the American Cancer Society, simple cysts do not increase the risk of breast cancer. That said, there is a small chance that complex cysts may contain cancer or increase a person’s risk of cancer later on, depending on the results of a biopsy.

Read more about breast lumps here.

Chalazion cysts

Very small eyelid glands, known as meibomian glands, make a lubricant that comes out of tiny openings in the edges of the eyelids. Cysts can form here if the ducts are blocked. These are known as chalazion cysts.

Colloid cysts

Colloid cysts develop in the brain and contain gelatinous material.

Treatment depends on whether the cyst is causing symptoms or a buildup of fluid in the brain. In these cases, a doctor may recommend surgery to remove the cyst or aspiration (draining).

Dentigerous cysts

Dentigerous cysts surround the crown of an unerupted tooth.

Dermoid cysts

Dermoid cysts comprise mature skin, hair follicles, sweat glands, and clumps of long hair, as well as fat, bone, cartilage, and thyroid tissue.

They can form anywhere on the body.

Epidermoid cyst

A 2021 article notes that people may also refer to these as “sebaceous cysts.” However, these cysts do not involve the sebaceous gland, and healthcare professionals call them epidermoid cysts instead.

These cysts occur on the skin of the face, back, scalp, or scrotum and contain keratin material.

Epididymal cysts

Epididymal cysts, or spermatoceles, form in the vessels attached to the testes.

They are benign and contain a fluid that is white and cloudy. They also contain sperm.

They are not a serious medical issue and rarely need treatment. However, treatment may be necessary if they cause pain or become too large.

Read more about testicle lumps here.

Ganglion cysts

Ganglion cysts are small, benign cysts that form on or near a joint or covering of a tendon.

They usually develop on the wrist and hand but can also appear on the foot, ankle, or knee.

Hydatid cysts

Hydatid cysts develop due to a relatively small tapeworm. These cysts form in the lungs or liver.

Treatment options include surgery and medication.

Kidney cysts

There are several types of kidney cysts, or renal cysts. They are usually harmless.

Solitary cysts contain fluids, sometimes including blood. Some are present at birth, while tubular blockages cause others.

People with renal vascular diseases may have cysts that formed due to dilatation of the blood vessels.

Ovarian cysts

Ovarian cysts are common in females who have regular periods. They form during ovulation.

The majority of ovarian cysts are benign and cause no symptoms. However, some can become so large that the abdomen protrudes.

Polycystic ovary syndrome refers to when the ovaries develop many small cysts.

Pancreatic cysts

Health professionals may refer to them as “pseudocysts” because they do not contain the types of cells present in true cysts.

They occur when the cells of the pancreas are injured or inflamed. They can also occur when pancreatic enzymes leak and damage the tissue of the pancreas.

Periapical cysts

Periapical cysts, also known as radicular cysts, are the most common type of odontogenic cysts, which are related to the formation and development of teeth.

These cysts usually develop due to inflammation of the pulp, pulp death, or tooth decay.

Pilar cysts

Pilar cysts are also known as trichilemmal cysts. They are fluid-filled cysts that form from a hair follicle and usually develop in the scalp.

Pilonidal cysts

Pilonidal cysts form in the skin near the tailbone or lower back, and they sometimes contain ingrown hair.

These cysts can grow in clusters, which sometimes creates a hole or cavity in the skin.

Pineal gland cysts

These are benign cysts that form in the pineal gland in the brain.

According to a review from 2020, pineal gland cysts are common.

Tarlov cysts

Tarlov cysts — also known as perineural, perineurial, or sacral nerve root cysts — occur at the base of the spine and are filled with cerebrospinal fluid.

Vocal fold cysts

There are two types of vocal fold cysts: mucus retention cysts and epidermoid cysts.

Vocal fold cysts can interfere with the quality of a person’s speech, sometimes causing their vocal cords to produce:

• multiple tones simultaneously, known as diplophonia
• breathy speech, or dysphonia
• hoarseness

The signs and symptoms will vary widely depending on what type of cyst it is. In many cases, a person first becomes aware of an abnormal lump, particularly when the cyst is just beneath the skin.

Many internal cysts, such as those that occur in the kidneys or the liver, may not cause any symptoms at all. A person may not notice them until an imaging scan — such as an MRI, CT, or ultrasound scan — detects them.

It is unusual for some cysts, such as skin cysts, to cause pain unless they rupture, become infected, or are inflamed. However, breast cysts can cause pain.

A person may also experience headaches and other symptoms if a cyst develops on the brain.

Cysts are common and can occur anywhere on the body. They can be a result of infection, clogged sebaceous glands, or piercings.

Some other causes of cysts include:

• tumors
• genetic conditions
• a fault in an organ of a developing embryo
• a defect in the cells
• chronic inflammatory conditions
• blockages of ducts in the body that cause fluids to build up
• a parasite
• an injury that breaks a vessel

Cysts are usually benign and develop due to blockages in the body’s natural drainage systems.

However, some cysts may be tumors that form inside tumors. These can be malignant, or cancerous.

Cysts are not the same as tumors.

Learn about tumors versus cysts here.

The treatment options for a cyst will depend on a range of factors, including the type of cyst, where it is, its size, and the degree of discomfort it is causing.

For very large cysts that are causing symptoms, a doctor may recommend surgical removal.

Sometimes, a doctor can drain, or aspirate, the cyst by inserting a needle or catheter into the cavity. If the cyst is not easily accessible, they may use radiologic imaging to accurately guide the needle or catheter.

A healthcare professional may examine the removed liquid under a microscope to determine whether or not any cancerous cells are present. If they suspect that the cyst is cancerous, they may suggest surgical removal, order a biopsy of the cyst wall, or both.

Some cysts develop as a result of a chronic or underlying medical condition, as may be the case with fibrocystic breast disease or polycystic ovary syndrome. In such cases, the focus of the treatment will be on the medical condition itself, not the cyst.

Although cysts and boils can appear similar in appearance, their causes and treatment options are different.

A cyst is a closed sac that consists of liquid, gaseous, or semisolid material.

A boil is a lump that has filled with pus and develops around hair follicles. They usually occur as a result of a bacterial infection.

Learn more about cysts versus boils here.

Cysts are abnormal, fluid-filled sacs that can develop in tissues in any part of the body. They are relatively common, and there are many different types.

Infections, tumors, parasites, and injuries can cause cysts. They are usually noncancerous.

If a person is worried about a cyst or has noticed a new lump, they should see a doctor for an accurate diagnosis and treatment, if necessary.

Ultrasound – ultrasound in the presence of ovarian cysts

Ultrasound in gynecology is used to diagnose diseases of the female reproductive organs. This is a fairly common, completely safe, highly informative and easy method. An ovarian cyst on ultrasound is visualized as a cavity formation.

Ultrasound of the pelvic organs

Ultrasound of the pelvic organs is used in the diagnosis of various gynecological diseases, urgent conditions, for monitoring treatment and as a screening study. The method has no contraindications. It does not require preparation. Ultrasound of the pelvic organs, on which the ovarian cyst is visualized, is performed transabdominally or transrectally. Since transabdominal ultrasound is performed with a full bladder, the patient is advised to drink one liter of fluid an hour before the procedure.

For echography, devices with sectoral transabdominal and vaginal sensors are used. The frequency of the first of them is in the range from 3.5 to 5 MHz, and the second – from 5 to 7.5 MHz. Transabdominal sensors look at women with a full bladder. Before using the vaginal sensor, it is processed according to a special technique, and then a sound-conducting gel is applied to the scanning surface, after which a condom is put on. If a woman is of reproductive age, then an ultrasound for an ovarian cyst is best performed either at the end of menstruation, or one or three days before the start.

Doppler ultrasound determines the following parameters:

• number of vascularization zones;
• Mosaic flow present or absent;
• pulsation index;
• resistance index;
• maximum systolic blood flow velocity.

Interpretation of ultrasound results is based on analysis of internal echostructure of the lesion, echogenicity, sound conduction, and contour evaluation. After the study is completed, the doctor gives a conclusion about the structure of the formation (solid, cystic or solid cystic), and also makes a conclusion about the nosological affiliation. Dopplerography is often used in the differential diagnosis of malignant and benign and ovarian neoplasms.

Normal ovarian ultrasound

In women of reproductive age, the ovaries are about four centimeters long, three centimeters wide, and two centimeters thick. On transvaginal scanning, multiple follicles are visualized in the ovarian parenchyma, which have a diameter of 0.3 to 0.6 cm. In the middle of the menstrual cycle, a dominant follicle with a diameter ranging from 1.8 cm to 2.4 cm can be seen. It is a formation of a round shape, having an anechoic or heterogeneous structure and thick walls. Its diameter is two centimeters, by the beginning of the next cycle it gradually decreases in size. If a woman is in menopause, then her follicular apparatus disappears and the size of the ovaries gradually decreases.

Ultrasound can also detect an ovarian cyst in polycystic ovary syndrome. The disease has the following echographic features:

• the uterus is reduced due to its thickness;
• the size of the ovaries is increased;
• no dominant follicle or corpus luteum;
• , the number of follicles, which are located diffusely, is increased, and there are practically no differences in their diameter.

In order to facilitate ultrasound diagnosis of diseases of the reproductive organs, including ovarian cysts, it is proposed to calculate the ovarian-uterine index. It is the ratio of the average volume of the ovaries to the thickness of the uterus. In the case when the ovarian index is higher than 3.5, then this is evidence of polycystic ovaries. If it is less than the threshold value, then according to ultrasound, there is no ovarian cyst.

Ovarian cyst on ultrasound

In most cases, ultrasound reveals functional ovarian cysts, which include follicular cyst and corpus luteum cyst. On ultrasound, the follicular ovarian cyst has a round or egg-like shape. Its inner surface is smooth, and the wall is rather thin. Its thickness is about one millimeter. The internal content of the cyst is homogeneous, has an anechoic structure. Its diameter can be different – from three to ten centimeters. A follicular ovarian cyst ceases to be visible on ultrasound three months after it occurs.

Cysts of the corpus luteum form after ovulation. They are rounded, the wall can have a thickness of two to six millimeters. The size of the corpus luteum cyst can be different – from three to seven centimeters. Their content in most cases is anechoic, has a cobweb-like or mesh structure. They may contain partitions of irregular shape and various sizes. In the formation cavity hyperechoic inclusions, which are represented by blood clots. On ultrasound, ovarian corpus luteum cysts become invisible within three weeks.

In almost one hundred percent of cases, blood flow is determined in the ovarian corpus luteum cyst by ultrasound. However, in the presence of a corpus luteum cyst, low values ​​of the resistance index can be determined, which are combined with a high maximum systolic blood flow velocity.

In hyperstimulated ovary syndrome and in case of hydatidiform mole, a thecalutein ovarian cyst occurs. On ultrasound, they can be visible from one or both sides and are multi-chamber formations, the diameter of which can be in the range of 4-8 centimeters. The stack of such a cyst is thin, about one millimeter. Its contents are anechoic, homogeneous. After the elimination of the pathological process, the cyst gradually disappears. After the patient’s pathological focus is eliminated, the teculutein cysts are not visible on ultrasound, as they regress.

Endometrioid ovarian cysts appear round or oval on ultrasound. They are in most cases located behind the uterus. The size of the endometrioid cyst can be different – from one to eight centimeters. Their wall thickness can vary from two to six millimeters. Its internal contents are filled with a highly echogenic or medium echogenic suspension, which does not move during the percussion of this formation. The presence of a double wall contour is considered one of the main ultrasound signs of an endometriotic cyst. In eighty percent of cases, blood flow is recorded in the wall of the endometrioid ovarian cyst on ultrasound.

Paraovarian ovarian cyst is formed in embryogenesis, but begins to increase during puberty. It reaches its maximum development by puberty. A paraovarian ovarian cyst on ultrasound has dimensions from three to twelve centimeters in diameter. Sometimes huge paraovarian cysts are revealed. Their walls are thin, about one centimeter. The content has a homogeneous structure, it is anechoic. In the contents of the paraovarian ovarian cyst, ultrasound often reveals a delicate fine suspension, which shifts when tapped on the formation. The only reliable echographic sign of a paraovarian cyst is the presence of a separate ovary.

Teratomas are two to twelve centimeters in diameter. Their internal structure is very diverse. So, for example, on ultrasound, this ovarian cyst may contain only one hyperechoic component, which is fat. In other cases, various sizes are visualized, either a cystic dense hyperechoic component, or a dense component that gives a shadow due to the presence of bone rudiments in the cavity. Sometimes on ultrasound, this ovarian cyst has multiple small-streaked inclusions, and also, in the presence of hair, thin elongated hyperechoic structures. The blood flow in the presence of teratoma is not determined.

Of the pathological ovarian cysts, cystadenomas are the most common. They can be serous and mucinous. The latter are divided into papillary and smooth-walled. Smaller smooth-walled cystadenomas are mostly round, while larger ones are oval. The size of such formations can vary widely. Their diameter is from three to fifteen centimeters, and the wall thickness is not more than one millimeter.

Cystadenomas contain contents in the cavity, which in most cases are homogeneous, have an anechoic structure. Sometimes on ultrasound, such an ovarian cyst contains a low-echoic suspension that is displaced by percussion. In twenty percent of cases, partitions are determined inside the formation. Papillary serous cystadenomas are mostly round in shape. Their diameter is from three to twelve centimeters, and the walls can be from one to two millimeters thick. On ultrasound, the papillary ovarian cyst has one chamber. In their cavity, a medium-echoic suspension is predominantly determined, which is displaced during palpation. The main echographic sign of cystadenomas is the presence of growths on the inner surface, the diameter of which is in the range of 0.3–1 cm. They are round in shape and have a spongy texture.

Small mucinous cystadenomas are generally round, while larger ones may be oval. In most cases, they have a diameter that can vary from four to twenty centimeters. These cysts in some cases can occupy the entire abdominal cavity. These tumors have a pathognomonic echoscopic sign – a finely dispersed, medium-echoic, non-displaceable suspension, but multiple thin irregularly shaped septa.

Echoscopic diagnosis of ovarian masses

In addition to their cysts, fibroma is also referred to as tumor-like formations of the ovaries. This is a tumor of the stroma of the ovaries and the sex cord and stroma of the ovary. Fibroids have different localization. Their shape is round or oval. The size of the neoplasm can vary – they can have a diameter of several millimeters or huge sizes. In the latter case, the mass formation occupies almost the entire abdominal cavity. On ultrasound, ovarian fibromas have low sound conductivity and an anechoic internal structure. In the parenchyma of the tumor, an ovarian cyst can be detected on ultrasound at the site of tumor necrosis. In the presence of fibroids in ten percent of cases, the blood flow is determined, there is no mosaic.

Tumors of ovarian stroma and sex cord also include tecoma. In half of the cases, the tumor produces estrogens. Thecomas are mainly located on the side of the uterus. They have different sizes – from three to fifteen centimeters. The surface of the techome is predominantly smooth, the internal structure is homogeneous. Tumors have an average or increased echogenicity. On ultrasound, ovarian cysts in the thecoma cavity are extremely rare. Neoplasms have an average or increased sound conductivity. In the presence of thecoma during echoscopy, blood flow is recorded in almost all cases. In forty percent of cases there is a mosaic.

Granulosa cell tumors are clinically manifested by hyperestrogenism. They are most often located on the side of the uterus. The size of the formation can be different – from three to five centimeters. Small tumors are solid. They have medium or low echogenicity. At the same time, tumors of medium size have an average echogenicity. They have superior sound transmission. Echoscopy can often identify small liquid inclusions that have clear, even contours. In tumors with a diameter of more than nine centimeters, cystic inclusions are often detected, which are large. Many of them, due to the huge number of thin partitions, have a spongy structure.

Androblastomas are classified as sex cord and stromal tumors of the ovary. These tumors are masculinizing. On scans, tumors are mainly defined as round or oval formations located on the side or above the fundus of the uterus. The average diameter of an androster is ten centimeters. Their echogenicity is different, sound conductivity is increased. In thirty percent of cases, these tumors have a solid structure.

Masculinizing ovarian tumors include androsteromas. Their parenchyma is heterogeneous due to cystic formations with increased echogenicity. In the presence of androblastoma, arterial blood flow is ascertained in one hundred percent of observations.

Ultrasound of the pelvic organs reveals not only an ovarian cyst, but also other neoplasms of the uterine appendages. Many of them contain cystic inclusions. This research method is non-invasive and comfortable.

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Surgical treatment of cardiac echinococcosis: a clinical case | Chernov

Echinococcosis is an endemic parasitic disease in which the dog, sheep, wolf, jackal, fox, lynx, as a rule, are the final hosts, the carrier of the tapeworm [1]. Echinococcosis refers to chronic diseases caused by damage to human organs and tissues by the larvae of the tapeworm of the cyclophyllide order ( Cyclophyllidea ) echinococcus. Humans become infected by ingesting food and water contaminated with animal feces [1]. An echinococcus embryo, passing through the venous system of the intestine, can enter the liver, and then into the systemic circulation, after which it can enter any organ of the body [1]. Although an echinococcal cyst can affect any organ, the liver is most commonly affected (60%). The second most commonly affected organ is the lungs (20-30%), while the heart and brain are extremely rare, in 0.5-2% and 2% of cases, respectively [2][3].

We present a clinical case of surgical treatment of an echinococcal cyst of the heart.

Clinical case

A 22-year-old man was hospitalized in the cardiosurgical department No. 3 (09/12/2022) with complaints of pain in the left side of the chest, upper abdomen without any connection with physical activity, shortness of breath with minimal physical activity and periodically at rest.

From the anamnesis: he considers himself ill for about 2 weeks, when the above complaints appeared. In this connection, he was examined at the place of residence, an echinococcal cyst in the left ventricle (LV) was suspected. At the place of residence, the patient underwent computed tomography (CT) of the organs of the chest and abdominal cavity – no mass lesions were detected, effusion was detected in the pleural cavities, pericardium and abdominal cavity. With a diagnosis of LV mass formation, the patient was referred for hospitalization at the Federal Center for Cardiovascular Surgery of the Ministry of Health of Russia (Astrakhan). Heredity is not burdened. Bad habits – denies.

Preliminary diagnosis at admission: LV formation (parasitic LV cyst (echinococcosis)) with a breakthrough into the pericardial cavity.

Chronic heart failure II B. NYHA functional class III. ICD-10: I50.0

On examination, general condition of moderate severity. Consciousness is clear, adequate. Normosthenic physique, satisfactory nutrition. The skin is of normal color, moderate moisture, clean. Peripheral lymph nodes are not visually enlarged. The chest is symmetrical, its palpation is painless. Percussion above the lungs pulmonary sound. Auscultatory breathing is vesicular, it is carried out in all departments, there are no wheezing. On examination, the region of the heart is not visually changed. On auscultation: the heart sounds are muffled, the rhythm is correct. Heart murmurs are not heard. The pulse is of satisfactory filling, there is no deficit. There is no noise on the arteries of the neck. Pulsation in the peripheral arteries of the feet is preserved. The tongue is moist and clean. The abdomen is soft, moderately painful on palpation in the upper sections, more on the right. There are no symptoms of peritoneal irritation. The liver percussion protrudes from under the edge of the costal arch +1 cm. The spleen is not palpated. The kidneys are not palpable. Tapping on the lower back painless on both sides. There are no peripheral edema. Saturation O ₂ – 98%.

In the general blood test at admission, eoinophilic leukocytosis was noted – (leukocytes – 12.27 and eosinophils 48.4%). In a biochemical blood test – alanine aminotransferase – 67.2 (reference values ​​0-41), creatinine 128 mmol/l (reference values ​​60-105 mmol/l), C-reactive protein 25.77 (reference values ​​0-6). According to the general analysis of urine at admission, proteinuria of 0. 18 g/l was detected.

According to the results of transthoracic echocardiography (EchoCG) (07.09.2022d) (Fig. 1 A, B): LV characteristics: LV end-diastolic volume — 64 ml; LV end-systolic volume — 14 ml; LV ejection fraction according to Simpson – 77%; right ventricle (RV): basal region – 3.15 cm; left atrium (LA) – 2.9 cm; LP volume — 40 ml. The chambers of the heart are not dilated. Global myocardial contractility is normal. There is no violation of local contractility. A multi-chamber formation is located in the LV cavity, occupying most of the LV cavity, attached and tightly connected, probably infiltrating the lateral wall of the LV, 6.45 × 4.1 cm in size, area 37 cm ² . LV diastolic function is not impaired. The systolic function of the pancreas is not impaired. Systolic pressure in the pulmonary artery 35 mm Hg. Separation of pericardial sheets behind the free wall of the pancreas 1.6 cm, behind the posterior wall of the left ventricle 0.7 cm, behind the lateral wall of the left ventricle 1. 7-1.8 cm, behind the vascular bundle 0.9 cm, behind the apex of the left ventricle 0.6-0.7 cm, behind the right atrium (RA) up to 2 cm, liquid with signs of organization. The wall of the pancreas with moderate collapse. Fluid is located in the left lateral pocket and small pelvis. Fluid in the pleural cavities on the left 5.5 cm, on the right 5.6 cm.

Fig. 1. Transthoracic echocardiography. A – parasternal access. A multi-chamber formation is visualized in the LV cavity, 6.44 × 4.1 cm in size, area 37 cm ² . B – four-chamber position, the length and width of the formation are indicated.

According to electrocardiography (07.09.2022) (Fig. 2), sinus rhythm was noted with a heart rate of 80 bpm. The electrical axis of the heart is horizontal. Signs of LV systolic overload.

Fig. 2. Electrocardiography.

The patient underwent a CT scan of the chest (08. 09.2022). Circular accumulation of fluid in the pericardial cavity without signs of collapse: 1.8 cm behind the RA, 1.6 cm behind the RV, 1.6 cm lateral to the LV, approximate volume 652 ml. In the LV cavity, there is a hypodense multi-chamber cystic formation 7.4 × 5.6 cm – echinococcus? (Fig. 3).

Fig. 3. CT scan of the heart.

There is a small amount of fluid along the posterior wall in the pleural cavity, 1.5 cm thick on the right, 1.2 cm on the left.

In order to exclude ischemic foci and space-occupying lesions in the brain, the patient underwent CT scan of the brain (01/11/2022) — no space-occupying lesions were detected. Ischemic changes and intracerebral hemorrhages were not detected.

Intraoperative transesophageal echocardiography (Fig. 4 A, B) (01/13/2022) showed: a multi-chamber formation is located in the LV cavity, occupying most of the LV cavity, infiltrating the lateral wall of the LV, with an area of ​​40 cm ² .

Fig. 4. Intraoperative transesophageal echocardiography. A – LV cavity, B – 3D echocardiography.

Access to the heart was through a median sternotomy. In the pericardial cavity there is an inflammatory adhesive process, a cloudy yellowish effusion with flakes, the pericardium is thickened up to 4 mm. Cardiolysis. During the revision, there was an infiltrate in the area of ​​the lateral wall of the left ventricle with a wall defect of up to 1.5 × 1 cm with the influx of serous-fibrinous fluid and single balls with transparent contents. As well as a breakthrough of the echinococcal cyst of the heart into the pericardial cavity (Fig. 5 A, B). The pericardial cavity was treated with a hypertonic NaCl solution. The cyst wall of the lateral wall of the left ventricle was additionally dissected, the echinococcal cyst contains many daughter cysts of a grayish color with a transparent content ranging in size from 3 mm to 2 cm. The contents of the cyst and fragments of the chitinous membrane were removed. The residual cavity in the thickness of the LV wall measuring 6 × 4 × 3 cm was treated with contact germicides (hypertonic solution of sodium chloride and 85% solution of glycerol, exposure), with the LV cavity not reported, sutured.

Fig. 5. Intraoperative view. A – echinococcal cysts; B — inflammatory process in the pericardial cavity.

The early postoperative period was uneventful. On the 8th day. The patient was discharged home with a clinical diagnosis:

Main: LV formation (Echinococcus cyst) with a breakthrough into the pericardial cavity from 01.09.22. OSSN dated 01.09.22. ICD-10: D15.1.

Primary complication: chronic heart failure stage II B according to Strazhesko-Vasilenko. Functional class III according to NYHA, predominantly right ventricular type, decompensation.

Operation: removal of an echinococcal cyst of the heart from 09/12/2022.

AND with the following recommendations for drug therapy: Nemazol 400 mg x 2 times/day. for a month, then a break of 2 weeks, then according to the scheme (total 4 courses with breaks of 2 weeks each) + Torasemide 5 mg in the morning (long-term) + Spironolactone 50 mg in the morning (long-term) + Carvedilol 3.13 mg × 2 times / day. (ongoing) + Omeprazole 20 mg (1 month) + Acetylsalicylic acid 100 mg in the afternoon (ongoing).

Discussion

Echinococcosis of the heart was first described by Williams in 1836. In 1846, Griesinger reported 15 autopsy cases. The first successful surgical intervention was performed by Long at 1932g. The first successful operation for cardiac echinococcosis under cardiopulmonary bypass was reported [4][5]. The most common localization of echinococcal cysts are the liver (in 50-70% of cases), lungs (5-30%), muscles (5%), bones (3%), kidneys (2%), spleen (1%) and brain (1%). Echinococcosis of the heart is rare (0.5-2%) [4-6].

Echinococcal cysts increase in size slowly and are often asymptomatic [7][8], and the symptoms of cardiac echinococcosis are nonspecific, which, in turn, can make diagnosis difficult [9]. Symptoms will vary depending on the location of the cyst. Coronary blood flow is the main route by which parasite larvae reach the heart [10]. Due to the rich coronary blood supply, the LV in 55-60% of cases is the focus of echinococcosis of the heart, pancreas (10-15% of cases), pericardium (7%), pulmonary artery (6-7%), LA (6-8%), RA (3-4%) and interventricular septum (4-4%) [2][6][10][11]. Thus, the most common localization is the LV free wall, as in our case [7][12]. In general, surgical excision of cysts is the preferred treatment for echinococcus [7][8]. There are several complications associated with echinococcal cysts, among which the most serious is acute rupture of the cyst into the systemic circulation [7][8][12]. In addition, a life-threatening anaphylactoid reaction due to the antigenic nature of the cyst [8].

Early diagnosis of this condition is critical to preventing these complications. Chest radiographs usually show a normal cardiothoracic ratio or cardiomegaly [13]. Electrocardiographic findings vary depending on the location of the cysts. Echocardiography is simple and useful in the diagnosis of cardiac echinococcosis [13]. CT and magnetic resonance imaging (MRI) provide additional information such as the size and anatomical relationships of the cysts [2][6][14]. Serological tests can be false negative in 10-20% of patients with liver echinococcal cysts, 40% with pulmonary cysts, and 50% with cardiac cysts, this is most likely due to an insufficient immune response [5][6][15]. However, enzyme immunoassay is one of the most specific serological tests that can be used, and a positive result for echinococcus antibodies confirms the diagnosis.

The main method of treatment of such patients is a combined approach, which consists in surgical resection of intracardiac echinococcosis with washing of the remaining cavity with hypertonic saline and simultaneous therapy with albendazole. During surgery, care must be taken to avoid gross manipulation of the heart, and to fix the operating field with saline-moistened gauze to minimize local spread [3][16-18].

Conclusion

Although cardiac echinococcosis can be fatal, it is rare and often asymptomatic in the early stages. Therefore, clinical suspicion is important for a correct diagnosis. Echocardiography, CT and MRI are useful in the diagnosis and localization of cardiac echinococcosis. Combined surgical resection of intracardiac echinococcosis, lavage of the remaining cavity with hypertonic saline, and simultaneous therapy with albendazole is the main treatment for such patients.

Relationships and activities: all authors declare no potential conflicts of interest requiring disclosure in this article.

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