Ovarian Tumors 


Molly Jonna, MS4 and Jennifer Lim-Dunham, M.D.


What are the common ovarian masses?

What are the useful imaging modalities in evaluating an ovarian mass?

What is the utility of each procedure?

The radiographic evaluation of the patient depends on the age and clinical suspicion.  


Appropriateness Criteria:

The American College of Radiology has developed Appropriateness Criteria which are evidence-based guidelines that assist physicians in making the most appropriate imaging decisions for a wide variety of clinical conditions.

Appropriateness Criteria for clinically suspected adnexal mass states that transvaginal and transabdominal ultrasonography with Doppler is the test of choice. MRI is useful for further characterization of adnexal masses, while CT is rarely indicated for primary evaluation. Links to the criteria can be found below.

Link to women’s imaging recommendations:

Link to adnexal mass imaging recommendations:


What are the Imaging findings of ovarian cyst?

What are the radiologic findings of a malignant ovarian mass?

What are ovarian germ cell tumors?

What are the imaging findings in dermoid cysts and ovarian teratomas?

What is the clinical setting when you will consider an ovarian mass?

Take Home Points:

Dermoid Imaging


Image 1

The large right adnexal dermoid cyst depicted in this image between the red calipers has both fat and fluid components, which is a classic finding. The white x’s demarcate the hypochoic, or dark, fluid components of the cyst and the black x’s demarcate the echogenic, or white, fat components of the cyst.


Image 2

The left adnexal dermoid cyst has both fat and fluid components as well. The white arrowhead points towards an echogenic fat component. The white arrow points toward a fluid-fluid level that separates simple from complex fluid within the cyst. The echogenic, or white, dots and dashes that you see within the cyst represent hair within the cyst. This finding is known as a “dermoid mesh. “

 Teratoma Imaging 

Ovarian Teratoma

Image 1

The CT image shows a large ovarian teratoma between the white calipers. The white arrow points towards a hypodense fat component and the white arrowhead points towards an isodense solid component. The black arrow is pointing towards a hyperdense calcification, which is a classic teratoma finding. The black arrowhead shows a metallic,hyperdense IUD located within the patient’s uterus.

Ovarian Teratoma

Image 2

The US image shows a teratoma which is outlined by the calipers. The white arrowheads point out hyperechoic calcification with posterior shadowing within the teratoma. The calibers are outlining the measurements of the tumor.

Ovarian Cyst Imaging

Simple ovarian cyst


Calipers demarcate a 4.3 cm fluid-filled  cyst arising from the left ovary which demonstrates the features of a simple cyst: anechoic, or completely black echotexture; thin, imperceptible wall; and posterior acoustic shadowing in which the tissues posterior to the cyst are more echogenic, or whiter, than the surrounding tissue.


Ovarian Cyst

Case 1

Patient is a 37 yr/o G3P2012 who comes to the ER complaining of severe abdominal pain.  Patient has had a similar pain in the past.  Patient has regular periods, which come every 28-30 days. Her LMP was 2 weeks ago.  She is afebrile.  On physical exam, she has right lower quadrant tenderness, with no rebound or guarding. Patient has no cervical discharge, no cervical motion tenderness, but does have right adenxal tenderness. 

CT pelvis . Left ovarian cyst.


Helpful links with Additional Imaging:

  1.  http://emedicine.medscape.com/article/404450-overview#a22
  2.  http://www.med-ed.virginia.edu/courses/rad/edus/pelvic1.html
  3.  http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma - Imaging is found on the right side of the article
  4. http://pubs.rsna.org/doi/figure/10.1148/radiographics.21.2.g01mr09475



  1. Gershenson, D. M. (2013). Ovarian germ cell neoplasms: Pathology, clinical manifestations, and diagnosis. In S. Falk, B. Goff, A. Pappo & R. Garcia (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/ovarian-germ-cell-neoplasms-pathology-clinical-manifestations-and-diagnosis?source=search_result&search=Teratoma&selectedTitle=1~88
  2. Outwater, E. K., Siegelman, E. S., & Hunt, J. L. (2001). Ovarian teratomas: Tumor types and imaging characteristics. RadioGraphics, 21(2), Retrieved from http://pubs.rsna.org/doi/full/10.1148/radiographics.21.2.g01mr09475