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Pelvis » Female Pelvis (Gynecology)
Left ovarian dermoid
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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.
 
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