Most patients are asymptomatic 4.
Cysts form as a result of an obstruction of the gland's duct by a stone/ stenosis related to prior infection or trauma 6. Chronic inflammation can lead to ductal obstruction from pus or thick mucus which in turn can result in retained secretions within the Bartholin glands.
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).
May only be demonstrated on trans-perineal ultrasound if the cyst is close to the labia.
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
- 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.
General imaging differential 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 above the level of the pubic symphysis helps to differentiate them from Bartholin duct cysts.
- Nabothian cyst: located at a much higher position within 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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