Kissing Ovaries Sign: Visual Reference
I cannot provide actual photographs or images, but I can describe what the "kissing ovaries" sign looks like on ultrasound and MRI imaging to help you recognize it.
What the Kissing Ovaries Sign Looks Like
The "kissing ovaries" sign refers to both ovaries positioned posterior to the uterus in the cul-de-sac (pouch of Douglas), appearing to touch or "kiss" each other in the midline 1, 2.
Key Imaging Features to Recognize:
On Transvaginal Ultrasound:
- Both ovaries are visualized posterior to the uterus rather than in their normal lateral positions
- The ovaries are in direct contact with each other or immediately adjacent in the midline
- They appear tethered within abnormal pelvic soft tissue 2
- Often accompanied by obliteration of the pouch of Douglas 3
On MRI:
- Ovaries positioned posterior to the uterus and in contact 4
- Distinguished from "retropositioned ovaries" where they are posterior but not touching 4
- May be part of a larger conglomerate mass incorporating both ovaries, uterine serosa, and potentially bowel 5
Clinical Significance
This sign is strongly associated with moderate to severe (stage III-IV) endometriosis 1, 4:
- 100% of cases with kissing ovaries had stage III or IV endometriosis in one study 4
- Sensitivity of 82.8% and specificity of 69.2% for predicting bowel endometriosis 3
- Associated with bowel involvement in 61.1% of cases (OR=10.3) 3
- Strongly associated with fallopian tube involvement (92.6% vs 33%) and tubal obstruction 1
Where to Find Images:
For actual photographs of this sign, consult:
- The original 2005 Fertility and Sterility publication by Ghezzi et al. 1
- The 2024 Radiology consensus guideline figures 6
- The 2020 Abdominal Radiology MRI study 4
- Educational radiology teaching files and endometriosis imaging atlases
The presence of this sign warrants surgical consultation and multidisciplinary planning, as it indicates severe disease requiring specialized surgical expertise 5.