GYN Image Quiz

The many faces of dermoid

OBG Manag. 2017 September;29(9)

Dr. Kanmaniraja is Assistant Professor and Chief, Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine-Jacksonville.

Dr. Kaunitz is University of Florida Term Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville. He is Medical Director and Director of Menopause and Gynecologic Ultrasound Services at UF Women's Health Specialists-Emerson. He also serves on the OBG Management Board of Editors.

The authors report no additional financial relationships relevant to this quiz.

Can you identify which feature of an ovarian dermoid cyst is found on these ultrasound images?

A 49-year-old woman with pelvic discomfort presents to her gynecologist. Physical exam suggests unilateral adnexal fullness; the gynecologist orders transvaginal pelvic ultrasonography.

Recognizing that, in a given patient, multiple features of an ovarian dermoid cyst may be imaged, which imaging feature of a dermoid is illustrated above?

Choose one

	Dermoid plug
	Tip-of-the-iceberg sign
	Dot-dash pattern
	Fat-fluid level

A) Dermoid plug CORRECT
The most common appearance of an ovarian dermoid is a cystic lesion with a focal echogenic nodule protruding into the cyst (Rokitansky nodule).¹

Transvaginal pelvic ultrasounds on 2 different patients demonstrate focal echogenic nodules (long arrows) protruding into the cyst (Rokitansky nodule).

B) Tip-of-the-iceberg sign INCORRECT
The next most common appearance of an ovarian dermoid is a focal or diffuse hyperechoic mass with areas of sound attenuation from the sebaceous material and hair, often called the tip-of-the-iceberg sign.¹

Transvaginal pelvic ultrasounds from 2 different patients demonstrate focal hyperechoic masses (long arrows) with areas of sound attenuation (arrowheads) precluding delineation of the entire dermoid.

C) Dot-dash pattern INCORRECT
The 3rd most common appearance of an ovarian dermoid is a cystic lesion with multiple thin echogenic bands (lines and dots) that visualize hair floating within the cyst.¹

Transvaginal pelvic ultrasounds of the right ovary (transverse and longitudinal views of the same ovary) demonstrate a cystic lesion with multiple thin echogenic bands (lines and dots) showing hair floating within the cyst (long arrows).

D) Fat-fluid level INCORRECT
The 4th most common appearance of an ovarian dermoid is a result of the echogenic sebum and hypoechoic serous fluid causing a fat-fluid level.¹

Transvaginal pelvic ultrasound of the left ovary demonstrates a cystic lesion with echogenic sebum (long arrow) and hypoechoic serous fluid causing a fat-fluid level (short arrow).

References

Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. RadioGraphics. 2001;21(2):475–490.

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The many faces of dermoid

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