Diagnostic Ultrasound - Abdomen and Pelvis

Bartholin Cyst
TERMINOLOGY
Definitions
• Bartholin glands (or greater vestibular glands) are mucussecreting
glands located in vulvar vestibule, just lateral and
inferior to vaginal introitus
• Drain via narrow duct 2.5 cm in length
• Cystic dilatation of Bartholin gland occurs secondary to
duct obstruction
IMAGING
General Features
• Best diagnostic clue
○ Palpable, and sometimes visible mass lateral and inferior
to vaginal introitus
○ Most common vulvar cystic mass
○ Size ranges 1-4 cm
• Location
○ Posterolateral distal vaginal wall, medial to labia minora,
and at level of introitus
Ultrasonographic Findings
• Grayscale ultrasound
○ Cystic structure: Anechoic to mixed echogenicity if
complicated by hemorrhage or infection; may contain
septations
○ Thick walled if infected
• Power Doppler
○ No internal vascularity, may see reactive hyperemia
around Bartholin abscess
MR Findings
• T1WI
○ Low signal fluid if uncomplicated, signal may ↑ with
infection or hemorrhage
• T2WI
○ High signal fluid if uncomplicated, proteinaceous fluid
may be lower signal than simple fluid
Imaging Recommendations
• Protocol advice
○ Clinical diagnosis: Imaging generally not required unless
complications suspected
CT Findings
• Hypo- to hyperdense cystic lesion near vaginal introitus
○ Any solid component within should raise concern for
malignancy
DIFFERENTIAL DIAGNOSIS
Other Labial Masses
• Sebaceous cyst: Epidermal inclusion cysts, may become
infected, respond well to incision and drainage
• Thrombophlebitis or other infections
• Hematoma: Straddle injury, abuse
• Tumors: Rare, usually clinically obvious
• Endometriosis/endometrioma
Vulval Varices
• Associated with pelvic congestion syndrome
• Throughout vulva, not limited to vestibule
Gartner Duct Cyst
• Similar in appearance but in anterolateral wall of proximal
vagina
Skene Gland Cyst
• Periurethral in origin and separate from vaginal wall
PATHOLOGY
General Features
• Etiology
○ Obstruction of normal Bartholin gland duct
Microscopic Features
• Body of gland contains mucinous acini, duct has mixed
squamous, mucinous, and transitional epithelial cells, and
duct orifice is mostly squamous cells
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Usually asymptomatic
○ 1-4 cm, but can increase in size with repeated sexual
stimulation
○ Can result in dyspareunia
○ Can become painful due to infection
Demographics
• Epidemiology
○ Approximately 2% of women
○ Can typically become symptomatic in 2nd to 3rd decade
of life, but seen in all ages
Natural History & Prognosis
• Most are uncomplicated
• If infected → Bartholin abscess
○ Perineal pain, tender labial mass
○ Multimicrobial or related to gonorrhea/chlamydia
○ Increased size of preexisting mass
• Carcinomas are rare (1% of all gynecologic malignancies
and 0.1-0.5% of vulvar carcinomas)
○ 80% are either squamous or adenocarcinoma
Treatment
• Abscess
○ Incision/drainage ± silver nitrate cautery
○ Marsupialization or excision for recurrent cases
– Broad-spectrum antibiotics after surgical drainage
○ Placement of Word catheter
– Outpatient or ER treatment
– Limited by tendency to dislodge
SELECTED REFERENCES
1. Hosseinzadeh K et al: Imaging of the female perineum in adults.
Radiographics. 32(4):E129-68, 2012
2. Kushnir VA et al: Novel technique for management of Bartholin gland cysts
and abscesses. J Emerg Med. 36(4):388-90, 2009
3. Ergeneli MH: Silver nitrate for Bartholin gland cysts. Eur J Obstet Gynecol
Reprod Biol. 82(2):231-2, 1999
4. Hill DA et al: Office management of Bartholin gland cysts and abscesses. Am
Fam Physician. 57(7):1611-6, 1619-20, 1998
5. Yuce K et al: Outpatient management of Bartholin gland abscesses and cysts
with silver nitrate. Aust N Z J Obstet Gynaecol. 34(1):93-6, 1994
Diagnoses: Female Pelvis
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