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Click Initial visit. Tranvaginal images of a 36-year-old female with tubo-ovarian abscess. The transvaginal ultrasound images showing a complex left adnexal cystic structure demonstrating homogenous internal debris and fluid-fluid level, without significant hyperemia on color Doppler. This was thought to represent an endometrioma or a dermoid cyst.

Click Follow-up visit. 36-year-old female with left tubo-ovarian abscess. The transvaginal ultrasound showing increase in the size of the previously noted complex left adnexal cystic structure demonstrating internal debris, fluid-fluid level and the Doppler interrogations reveling hyperemic thick walls. These findings are consistent with left tubo-ovarian abscess

Click 36-year-old female with left tubo-ovarian abscess. CT scan of the abdomen with oral and intravenous contrast of 36-year-old female with left TOA, follow-up visit. A coronal CT reconstruction of the abdomen and pelvis with oral and IV contrast on arterial phase shows a large left adnexal cystic mass with thickened enhancing walls and several low-density tubular appearing structures with surrounding soft tissue density in the left hemipelvis adjacent to the large mass, likely focal pyosalpingitis. The mass is displacing the uterus inferiorly and to the right.

Click 36-year-old female with left tubo-ovarian abscess. CT scan of the abdomen with oral and intravenous contrast of 36-year-old female with left TOA, follow-up visit. A coronal CT reconstruction of the abdomen and pelvis with oral and IV contrast on arterial phase shows a large left adnexal cystic mass with thickened enhancing walls and several low-density tubular appearing structures with surrounding soft tissue density in the left hemipelvis adjacent to the large mass, likely focal pyosalpingitis. The mass is displacing the uterus inferiorly and to the right.

Click 36-year-old female with left tubo-ovarian abscess. CT scan of the abdomen with oral and intravenous contrast of 36-year-old female with left TOA, follow-up visit. A coronal CT reconstruction of the abdomen and pelvis with oral and IV contrast on arterial phase shows a large left adnexal cystic mass with thickened enhancing walls and several low-density tubular appearing structures with surrounding soft tissue density in the left hemipelvis adjacent to the large mass, likely focal pyosalpingitis. The mass is displacing the uterus inferiorly and to the right.

Click Complementary case. 47 year-old female comes to the ED with left flank pain. Axial noncontrast CT demonstrating a rounded hypodense structure in the left adnexal region displacing the bladder inferiorly, with attenuation values greater than simple fluid and smooth thin walls. The curved arrow demonstrated the uterus. The finding was suspicious for an endometrioma versus a hemorrhagic ovarian cyst.

Click Complementary case. 47 year-old female comes to the ED with left flank pain. An axial and a reconstructed coronal image from a noncontrast CT image demonstrating a rounded hypodense structure in the left adnexal region displacing the bladder laterally, with attenuation values greater than simple fluid and smooth thin walls. This finding was suspicious for an endometrioma versus a hemorrhagic ovarian cyst.

Click Complementary case. 47 years old female presented with incidental cystic adnexal mass identified on renal stone protocol CT. The transvaginal ultrasound demonstrated a large left adnexal cystic structure with smooth walls filled with debris and a fluid-fluid level level and without hyperemia in the walls, favoring an endometrioma, which correlated with patient's known history of endometriosis.