Figure 7a. Tubo-ovarian actinomycosis in a 29-year-old woman. The TOA has a predominantly cystic appearance. (a) Axial T2-weighted MR image shows a cystic mass (solid arrows) in the right adnexal region. Note the eccentric wall thickening extending posteriorly into the presacral space (open arrows). (b) Sagittal T2-weighted MR image shows that the distal right ureter (arrows) is encased by the mass. (c) Axial contrast-enhanced fat-suppressed T1-weighted MR image shows that the mass (arrows) has a multilayered wall with good enhancement of the eccentric wall thickening.