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Pelvis » Female Pelvis (Gynecology)

Left ovarian dermoid

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Author(s) :

Haroon Durrani, MD

Chaitali Shah, FRCR

Presentation A 35 year old woman presented with pain in left lower abdomen of 2 months duration. There were no other associated symptoms. An ultrasound of the pelvis was performed.

Caption: Transvaginal image of the left adnexa

Description: A highly echogenic left ovarian mass is identified. The posterior margins of the mass appear obscured. Compressed normal ovarian tissue with a few follicles is seen peripherally.

Caption: Coronal image of left ovary

Description: The left ovarian mass shows a highly echogenic content characteristic of lipid deposit or calcification. There is shadowing noted from the margin of the mass, possibly representing calcification.

Differential Diagnosis Left ovarian mass – dermoid, calcified cyst, malignancy

Final Diagnosis Left ovarian dermoid

Discussion These images of an ovarain benign cystic teratoma (“dermoid”) demonstrate the classic `tip of iceberg sign`, which, according to Rumack et al, results from an echogenic dermoid mass producing ill-defined acoustic shadowing that obscures the posterior borders of the mass. This occurs due to the contents of the dermoid [matted hair and sebum] that creates a large number of small scattering reflective interfaces and hence the “dirty“ shadowing.

Case References 1. Carol Rumack, Stephanie Wilson, et al. Chapter 15-The uterus and Adnexa by Shia Salem. Diagnostic Ultrasound -Volume One.

Follow Up The left dermoid cyst was surgically confirmed.