The symptoms of acute torsion are, however, very marked. The woman is seized with sudden and violent pain in the abdomen, accompanied by vomiting and collapse. Sometimes the abdomen becomes rapidly increased in size on account of the venous engorgement of the tumor. If a woman known to have an ovarian tumor is thus attacked, the diagnosis of torsion of the pedicle may be made. The diagnosis is rendered more probable if the woman is also pregnant or if she has been recently delivered. If the woman presents herself for the first time to the physician with these acute symptoms, and he finds by abdominal and pelvic examination that there is an ovarian tumor, he should suspect that torsion of the pedicle has occurred. _Rupture of the Cyst._--Rupture of an ovarian cyst usually follows a fall, a violent attack of coughing, vomiting, etc. The woman is seized with sudden pain in the abdomen, with perhaps symptoms of collapse and loss of blood. The shape of the abdomen becomes quickly altered from that characteristic of encysted fluid to that characteristic of free fluid in the peritoneum. The alteration in shape is so marked that it may readily be perceived by the patient. These phenomena are followed by profuse diuresis, or perhaps by symptoms of peritoneal inflammation. If the woman survive, there is a gradual reaccumulation of fluid and a return of the abdomen to the former shape. =Examination.=--In the early stages of an ovarian cyst, while it is in the pelvic state of development, bimanual examination will reveal the condition. The tumor lies to the side, to the front, or behind the uterus. The uterus may be moved independently of the tumor. The cystic character of the growth may often be determined by palpation; fluctuation may be felt between the vaginal finger and the abdominal hand. If the tumor be intra-peritoneal, with a pedicle, it will be found to be movable, and may be pushed out of the pelvis up into the lower abdomen. If it be intra-ligamentous, the range of motion is limited, the tumor is situated lower in the pelvis, and is in closer relationship with the uterus. The shape of the tumor is usually spherical. In a multilocular cyst the surface may be lobulated; in a dermoid cyst the pultaceous character of the contents may sometimes be determined by pressure with the vaginal finger. When the tumor has attained a sufficient size to have extended into the abdomen, much may be determined by careful abdominal examination. The woman should lie upon the back, and all constricting clothing should be removed. The whole abdomen should be exposed. 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.