A Text-book of Diseases of Women

by Charles B. Penrose

The bulging or prominence caused by the cyst is usually apparent in a thin woman. It commonly occupies the middle of the abdomen, but when not very large may lie to either side.

Palpation reveals the smooth, spherical character of the growth, or the lobulated surface from the presence of secondary cysts. Perhaps an area of marked tenderness may be discovered, which often shows the seat of peritoneal inflammation and adhesion. In the papillomatous tumors that have become perforated, irregular masses of papillary growths may sometimes be felt through the abdominal walls, situated either on the surface of the tumor or in some other portion of the abdomen. The association of such masses with a cystic tumor of the ovary and ascites renders the diagnosis of papillary cysts very certain.

If the tumor is non-adherent and of medium size, it may be moved from side to side or upward in the abdomen.

Fluctuation may often be elicited by palpation, and is most marked in the unilocular cysts with thin contents. If the contents be thick, as in many of the glandular cysts, or if the cyst be multilocular, fluctuation may not be obtained. The wave of fluctuation is interfered with by intervening septa.

Percussion reveals a central area of flatness which marks the most prominent part of the tumor. Intestinal resonance may be obtained above and to the sides of the cyst, and in some cases below it. In instances of this kind a central area of flatness is found surrounded by a ring of resonance.

This phenomenon is very different from that which appears if the fluid accumulation is free in the peritoneum. In the latter case the fluid gravitates to the flanks when the woman is upon her back, and the intestines float to the front, so that there is a central area of resonance, with dulness to the sides. In the very unusual cases in which gas is contained in the cyst-cavity the area of flatness will be replaced by an area of a tympanitic note.

If the woman sits up or lies on either side, the relation between the areas of flatness and resonance is unaltered in the case of an ovarian cyst, while, as is well known, if the fluid be free it will gravitate to the most dependent portion of the abdomen.

Auscultation reveals nothing of importance in regard to ovarian tumors. It is of value in enabling one to make a differential diagnosis between an ovarian tumor and pregnancy.

Vaginal examination in the case of a large tumor shows the character and the position of the lower portion of the growth, and sometimes enables the physician to determine upon which side the tumor had started. In ruptured papillomatous cysts the papillary masses may sometimes be felt behind the uterus when they cannot be detected by the abdominal hand.

The details of the natural history and pathological features already given will often enable the physician to make a differential diagnosis among the different kinds of ovarian cysts. Such a differential diagnosis, however, is of no importance whatever, as all such tumors require similar operative treatment.