A term used to describe the sonographic appearance of a dense ovarian dermoid tumor.

A term used to describe the sonographic appearance of a dense ovarian dermoid tumor.

• A. Tip of the iceberg
• B. Snowstorm
• C. Ground glass
• D. String sign

Answer: (A)

Dense components inside an ovarian dermoid can dominate the ultrasound image, producing the tip of the iceberg sign. When a mature cystic teratoma contains substantial highly echogenic material—such as hair, fat, or calcifications—that material strongly reflects sound and causes posterior acoustic shadowing. This makes the visible portion of the mass look small and bright at the top, while the rest of the mass is concealed beneath the dense echogenic content, just like the tip of an iceberg protruding above water. This appearance is a helpful clue pointing to a dermoid, because simple cysts typically present as anechoic or only mildly echogenic and do not show a dense, shadowing mass that obscures the remainder of the lesion. Other descriptors aren’t as characteristic for this lesion. The snowstorm sign is classically associated with diffuse echogenic debris seen in a hydatidiform mole, not with a dense ovarian dermoid. Ground-glass appearance and the string sign aren’t standard terms used to describe the typical dermoid appearance on ultrasound.

Dense components inside an ovarian dermoid can dominate the ultrasound image, producing the tip of the iceberg sign. When a mature cystic teratoma contains substantial highly echogenic material—such as hair, fat, or calcifications—that material strongly reflects sound and causes posterior acoustic shadowing. This makes the visible portion of the mass look small and bright at the top, while the rest of the mass is concealed beneath the dense echogenic content, just like the tip of an iceberg protruding above water. This appearance is a helpful clue pointing to a dermoid, because simple cysts typically present as anechoic or only mildly echogenic and do not show a dense, shadowing mass that obscures the remainder of the lesion.

Other descriptors aren’t as characteristic for this lesion. The snowstorm sign is classically associated with diffuse echogenic debris seen in a hydatidiform mole, not with a dense ovarian dermoid. Ground-glass appearance and the string sign aren’t standard terms used to describe the typical dermoid appearance on ultrasound.