Which ultrasound finding is most characteristic of Krukenberg tumors?

• A. Bilateral ovarian masses with posterior enhancement and ascites
• B. Unilateral ovarian cyst
• C. Solid uterine mass
• D. Ovary with papillary projections

Answer: (A)

Krukenberg tumors are metastatic cancers to the ovaries, most commonly from a gastric primary, and the ultrasound hallmark is bilateral ovarian involvement. Seeing masses in both ovaries with features of malignancy and accompanying ascites points strongly to metastatic disease rather than a primary ovarian cyst or a uterine lesion. The masses are typically solid and can show vascularity on Doppler, reflecting neovascularity from metastatic spread. A unilateral ovarian cyst suggests a different, usually benign or primary process; a solid uterine mass implies a uterine-origin pathology; and an ovary with papillary projections alone does not capture the bilateral metastatic pattern with ascites. Therefore, the combination of bilateral ovarian masses and ascites best fits Krukenberg tumors.