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Before the use of ultrasound, many ovarian tumors remained undiagnosed until cesarean section oruntil they became symptomatic. Now, many symptomatic or non-symptomatic adnexal tumors arediagnosed by ultrasound during pregnancy follow-up.In most cases, the adnexal tumors discoveredduring pregnancy are benign with a maximum diameter of 5 cm. Approximately 70% of the cysticadnexal tumors identified in the first trimester resorb spontaneously until the beginning of thesecond trimester (usually those are functional cysts). Persistent adnexal tumors larger than 5 cmare generally mature teratomas (dermoid).In this case, at the emergency room a 34 year-old-women came with almost 20 weeks pregnancy, accusing acute abdominal pain, nausea andvomiting. One week before, the patient went for a routine ultrasound for pregnancy and the doctordiscovered a giant tumor larger than 15 cm (due to the size it could not be measured) with fluidcontent. Two days before the symptoms, the patient went for an abdominal MRI where a voluminouspelvic-abdominal cyst with almost 30 cm in diameter was discovered. Differential diagnosis:ovarian torsion or ruptured cyst complicating pregnancy. What is the correct diagnosis and what isto be done since there is a 20 weeks pregnancy?