Mature cystic teratomas may have a variety of appearances characterized by iso- to hyperechoic sebaceous material and calcification. The most common appearance consists of a cystic lesion with a very hyperechoic mural nodule with calcification (Rokitansky nodule/dermoid plug). Another appearance is that of a cystic lesion with diffuse internal echos with sound attenuation due to sebaceous material and hair with or without a fluid-fluid level. Yet another manifestation comprises a cyst with multiple small echogenic lines or bands caused by hair within the cyst (dot-dash pattern/dermoid mesh). Sometimes, as in this case, a striking appearance is created by non-dependent intracystic globules in the cystic fluid that look like floating balls. It is uncommon but almost pathognomonic of ovarian mature cystic teratoma.