Ovarian cysts in female infant and children before puberty
Type:Educational Electronic Presentation
Authors: José Eduardo Rosa, Rafaela Pereira, Manuel Abecasis, Luísa Lobo
Keywords:Ovarian cysts; Haemorrhagic Cysts; Teratoma Mature Cysts; Pre-pubertal girls; Ultrasound.
Educational objective

To review and illustrate the radiological features of adnexal cysts in female infants and children before puberty using ultrasound images.

To review and discuss management of ovarian cysts.

Fig. 1 – Ultrasound showing a neonatal follicular cyst (2 days of life) (a) and its normal involution (4 months) (b) in the left ovary (white arrow).

Topic Review

Ovarian cysts, in children and adolescents, are frequently present either during the neonatal period, with a peak incidence in the first year of life, or around the time of menarche. Most cysts are benign, including functional cysts and various benign neoplasms, and will resolve spontaneously. They can present with pain, but usually, they are incidental findings.

A detailed and accurate history and physical examination are of extreme importance.

The most common benign adnexal lesions identified in pediatric and adolescent patients are functional physiologic ovarian cysts or corpus luteum cysts.

Ovarian cysts are the most common cause of abdominal cysts in female fetuses and neonates, usually presenting in the third trimester. They are frequently unilateral and simple and can present with varying sizes. The cause is usually fetal gonadotrophins, maternal...

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Fig 2 – Ultrasound showing a mature cystic teratoma in the right ovary (white arrow).


Most of the time ovarian cysts are discovered incidentally by ultrasound, sometimes in prenatal ultrasounds.

The natural history of functional cysts is eventual regression, and persistence is suggestive of an organic tumor.

The management of an ovarian cyst in pre-pubertal girls depends on the clinical manifestations, size, and cyst appearance on ultrasound examination.

Radiologists must be aware that ovarian cysts are rarer in the pre-pubertal period than in the neonatal and pubertal periods. It’s also important to know that small size has no pathological meaning. Proper management of ovarian cysts can include follow-up or surgery.

Fig. 3 – Ultrasound showing an haemorrhagic cyst in the right ovary (white arrow).