Ovarian masses that show parenchymal echogenicity on ultrasound are more likely to have ovarian pathology than those that show no echogenicity. If the ovarian mass is anechoic on ultrasound, it means that it contains fluid and may be a physiologic follicle or benign cyst, such as growing follicle, mature unruptured follicle, luteinized cyst of the ovary, and inflammatory ovarian mass, etc., all of which may be characterized by anechoicity. If the ovarian mass shows parenchymal echogenicity under ultrasound, the risk of ovarian tumor is high. If the ovarian mass is full of punctate or mud-like strong echoes, it is mostly ovarian chocolate cyst; if there are solid nodules or uneven thickening of the wall of the sac, we should be wary of ovarian malignant lesions. Therefore, ovarian masses with parenchymal echoes are more likely to have ovarian lesions, even malignant lesions, than those without echoes.