Bartholin gland cyst
Dr Praveen Jha and Dr Jeremy Jones et al.
A Bartholin gland cyst is located in the postero-lateral inferior third of the vagina and is associated with the labia majora.
Clinical presentation
Most patients are asymptomatic 4
Pathology
Chronic inflammation can lead to ductal obstruction from pus or thick mucus which in turn can result in retained secretions within the Bartholin glands.
Radiographic features
General
They are typically seen as rounded unilocular cysts lying at the posterior aspect of the vagina. Their location is at or below the level of the pubic symphysis (best appreciated on coronal imaging).
Ultrasound
May only be demonstrated on trans-perineal ultrasound as the cyst close to the labia
MRI
Signal characteristics include
- T1 : can be of variable signal
- T2 : often of uniform hyper-intensity on T2-weighted imaging although can occasionally vary dependent on protein content, may also be heterogeneous when infected
Complications
- infection : may turn into Bartholin gland abscesses
- rare instances of development of adenocarcinoma or squamous cell carcinoma within cyst 5.
Treatment and prognosis
Infected or symptomatic cysts may require marsupialization
Differential diagnosis
General considerations include
- Bartholin gland abscess : may show associated inflammatory features
- Bartholin gland tumour : consider if discovered in the post-menopausal patient
- Gartner duct cyst : their location at or below the level of the pubic symphysis helps to differentiate them from Gartner duct cysts.
- Nabothian cyst : located at a much higher position with the uterine cervix
- Skene duct cyst : centered more anteriorly and closer to the external urethral meatus : sagittal imaging may help differentiate in some cases
- urethral diverticulum :
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