Normal Ovary — Follicular Phase

During the follicular phase (early-mid menstrual cycle) the ovary normally contains multiple small follicles of varying size. A dominant follicle may be visible as a follicular (anechoic) structure that progressively enlarges. This is a physiologic appearance and should not be mistaken for pathologic cysts when features are typical.

Key sonographic features — normal follicular-phase ovary:

• Multiple small anechoic follicles (typically 2–10 mm) scattered in the ovarian cortex
• Occasionally a dominant follicle (up to ~18–25 mm prior to ovulation)
• Anechoic (fluid-filled) round/ovoid follicles with thin walls and posterior acoustic enhancement
• No internal echoes, no mural nodules, and no internal vascular solid components within follicles
• Tubal/adjacent structures normal; no free fluid unless physiologic minimal amount

Clinical significance: This is a normal cyclic appearance. Dominant follicles grow prior to ovulation; follow-up is only required if a cyst persists >6–8 weeks, is symptomatic, or demonstrates suspicious features such as solid vascular nodules, papillary projections, or thick irregularized walls.

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Suggested caption for readers: Normal ovarian morphology in the follicular phase often shows multiple small follicles; one may become dominant. Typical follicles are simple, anechoic, mobile with probe pressure, and avascular internally on Doppler.