Ovarian Dermoid Cyst | Mature Cystic Teratoma | ORADS 3 || Ultrasound || Case 295

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Ovarian Dermoid Cyst | Mature Cystic Teratoma | ORADS 3 || Ultrasound || Case 295

Clinical Features:
A 16-year-old female patient came with a palpable lower abdominal lump

Ultrasound Features:
A well-defined, thin-walled, unilocular cystic lesion of about 11cm X 8.7cm size, casting posterior acoustic enhancement with a smooth inner margin, no papillary projection or septation is noted arising from the left adnexa & extending below the umbilical region more towards the right.
Multiple, round & oval, diffusely echogenic, sound attenuating masses are seen floating within the cyst cavity forming the ‘floating ball sign’, ‘meatballs sign’, ‘truffle sign’, ‘boba sign’ or ‘Pokemon ball sign’.
Numerous thin ‘echogenic lines & dots’ are seen within the fluid content forming the ‘dot-dash pattern’ indicating the dermoid mesh.
Echogenic components casting acoustic shadows are also noted within.
The left ovary could not be separately visualized. Rather, the ovarian stroma containing some small follicles is seen within the cystic lesion.
Color Doppler shows no flow within the echogenic intracystic masses.
No ascites or lymphadenopathy.

Remember:
An adnexal cyst with internal echogenic components showing sound attenuation or casting acoustic shadows is dermoid.
Check for increased vascularity & ascites to exclude malignant transformation.

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