Diagnostic Ultrasound - Abdomen and Pelvis

Nabothian Cyst
Diagnoses: Female Pelvis
TERMINOLOGY
• Most common pathologic process of cervix
• Mucus-filled cystic dilatation of endocervical gland
• Tunnel cluster: Type of nabothian cyst characterized by
complex multicystic dilatation of endocervical glands
IMAGING
• Best imaging clue: Circumscribed superficial unilocular cyst
in wall of cervix
○ Often multiple
○ Average size: 10-15 mm
• Important to identify relationship between nabothian cyst
and endocervical canal
• Debris within cysts is common
• Use color Doppler if cyst appears potentially solid
TOP DIFFERENTIAL DIAGNOSES
• Adenoma malignum (minimal deviation adenocarcinoma)
• Endocervical hyperplasia
KEY FACTS
• Uterine cervicitis
• Cystic endometrial polyp
• Cervical cancer
• Cervical ectopic pregnancy
• Abortion in progress
CLINICAL ISSUES
• Nabothian cysts are rarely symptomatic
• More common in women who have had children
• Treatment is rarely necessary
DIAGNOSTIC CHECKLIST
• Requires further evaluation with MR if
○ Solid components
○ Copious vaginal discharge
○ Deep cervical invasion
(Left) Transverse transvaginal
ultrasound through the cervix
shows a well-circumscribed
simple nabothian cyst ſt with
posterior acoustic
enhancement , separate
from the fluid-filled
endocervical canal . (Right)
Transverse transvaginal US
shows a simple nabothian cyst
ſt at the lateral margin of the
cervix. Real-time imaging
helped confirm the location
within the cervical stroma;
however, this image
demonstrates the potential for
misdiagnosis as an ovarian
follicle.
(Left) Transverse transvaginal
US shows a complex
nabothian cyst ſt with
internal echoes and peripheral
debris st, consistent with
inspissated mucus. The cyst is
adjacent to the cervical canal
. (Right) Longitudinal
transvaginal US shows a large
complex nabothian cyst ſt
with homogeneous internal
echoes, in addition to multiple
smaller nabothian cysts st.
The cervical canal is minimally
displaced but remains visible
.
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