Hemorrhagic Follicular Cyst in a Teenager

June 29, 2018

Sophia Capili, MD

Baylor Family Medicine at Garland, Garland, Texas

Kathryn King, MD
Pediatrics Department, UT Southwestern Medical Center, Dallas, Texas

Capili S, King K. Hemorrhagic follicular cyst in a teenager [published online October 30, 2017]. Consultant for Pediatricians.


A 16-year-old teenaged girl with no medical or surgical history presented with acute, cramping pain in the right lower quadrant that had begun at school while she was urinating.

The pain was severe and constant and radiated to her right shoulder but was not associated with meals. The pain worsened with movement, and there were no alleviating factors. She also had dizziness, nausea, decreased appetite, and suprapubic pain. She denied syncope, fever, weight loss, dysuria, hematuria, vomiting, diarrhea, constipation, or previous similar symptoms. Menarche had occurred at age 12 years with regular menses that lasted 6 days. She had no history of sexual partners. There was no family history of uterine, ovarian, or breast cancer.

Results of ultrasonography of the abdomen and pelvis showed right ovarian blood flow adjacent to a probable hemorrhagic cyst, but ovarian torsion could not be excluded (Figure 1). Her hemoglobin level was 9 g/dL (reference range, 12-15.4 g/dL) and remained stable. She had no signs of peritonitis during her hospital stay.

ovarian cyst figure 1
Figure 1. Pelvic ultrasonography scan with doppler shows a 5.5-cm right adnexal complex lesion that may represent a ruptured hemorrhagic cyst or, less likely, a neoplasm. Vascular evaluation of the right ovary is limited due to the large size of mass, which distorts local anatomy. Thus, torsion cannot be excluded.

A diagnostic laparoscopy was performed after her abdominal pain had persisted after 2 days. Old blood was found in all quadrants and was aspirated. The left ovary was normal. The right ovary was normal on the surface and without torsion but had a clot extruding from a ruptured hemorrhagic cyst. A portion of the clot was removed, but the remainder of the clot was left in place to avoid further bleeding.

The histopathology results from the ovarian wall biopsy were consistent with hemorrhagic follicular cyst. She recovered well and was referred to an adolescent/young adult medicine specialist for treatment to prevent future ovarian cysts associated with hormonal contraception.

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