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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