A tubo-ovarian abscess (TOA) is a complex infectious mass of the adnexa that forms as a sequela of pelvic inflammatory disease. Classically, a TOA manifests with an adnexal mass, fever, elevated white blood cell count, lower abdominal-pelvic pain, and/or vaginal discharge; however, presentations of this disease can be highly variable. Should the abscess rupture, life-threatening sepsis can result, thus any clinical concern for this diagnosis requires prompt evaluation and treatment.