Presentation
Lower abdominal pain.
Patient Data
There is a complex cyst seen in the left ovary. This measures about 3.2 x 2.3 cm with mixed echogenic and hypoechoic contents and the echogenic contents are seen floating on the surface of the hypoechoic contents. No abnormal Doppler signal was noted, suggesting a dermoid cyst.
The right ovary could not be visualised (obscured by gas).
Both ovaries reveal complex multilocular cysts within. These locules reveal fat content (hyperintense on T1W and signal loss on fat-suppressed sequences) suggesting dermoid cysts. The right ovarian dermoid cyst measures about 4.5 x 4 x 3.8 cm in its maximum dimensions. The left ovarian dermoid cyst measures about 4 x 3.4 x 3.2 cm in its maximum dimensions. Both dermoid cysts locules have thin walls and septations. Some locules contain floating solid contents within the fat. The left ovarian dermoid cyst reveals a fat fluid level. No enhancing components were noted in both cysts.
Case Discussion
The presence of fat is a specific sign for the dermoid cyst in all imaging modalities. On ultrasound, it gives a characteristic ill-defined echogenic shadow which is characterised as "tip of the iceberg" appearance. Also, the floating of fat on fluid contents is another characteristic sign on ultrasound. Sometimes, the fat may be mistaken for gases, which may explain the non visualisation of the right ovary.
These patients usually have partial oophorectomy to preserve the ovulation and hormonal function of the ovaries.
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