Presentation
Irregular menstrual period and lower abdominal pain.
Patient Data
There is a right adnexal cystic lesion that shows multiple echogenic floating balls.
There was no vascularization within the balls.
There is a cystic lesion arising from the right ovary showing multiple internal rounded lesions which appear of higher signal than the fluid on T1W and lower signal than fluid on T2 W images giving the appearance of floating balls sign, with evidence of restricted diffusion, and fat components, without evidence of enhancing solid component.
It measures 7 x 5.4 x 6.4 cm. It pushes the uterus and sigmoid to the left side.
Features are suggestive of right ovarian mature cystic teratoma.
Thin-walled fluid intensity cyst arising from left ovary measuring 4.7 x 3.6 x 5 cm.
Minimal pelvic free fluid.
Normal thickness of the endometrium.
No uterine masses.
Case Discussion
In rare cases, the presentation of MDCT is atypical, which can be a diagnostic challenge for radiologists.
Multiple small floating spheres within a large cyst, as observed in the case presented here, is one of those rare presentations, known as the “floating balls” presentation but it is pathognomonic for ovarian mature cystic teratoma.
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