A mature cystic teratoma of the ovary is called a dermoid cyst. This patient presented with a palpable lump per abdomen. The initial ultrasound scan showed the characteristic sonographic features of an ovarian dermoid cyst. CT abdomen was done later which confirmed the findings. This case highlights some of the classic features of an ovarian dermoid cyst viz. Rokitansky nodule, tip of iceberg sign, linear mesh of hair, fat-fluid levels and tooth/ossification within. Usually, ovarian dermoid cysts tend to be not more than 10 cm in size, but in this patient, the cyst was very large, reaching superiorly up to the level of the umbilicus.
Hence, based on the characteristic sonographic features, one can reliably make a diagnosis of ovarian dermoid cyst on ultrasound. When findings are not typical, a CT scan can confirm the diagnosis.