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We present the imaging and histopathological findings in a 32-year-old female who presented to the erectile dysfunction with progressively worsening abdominal pain over the past 2 months. Computed tomography abdomen and pelvis revealed bilateral ovarian teratomas, left significantly larger than right. There was associated fat stranding, mesenteric/omental stranding, and ascites worrisome for rupture versus peritoneal carcinomatosis. Histopathology confirmed a left immature teratoma (Grade 2), right mature teratoma, and peritoneal gliomatosis from possible tumor rupture before surgery.

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