This study was done to determine if there are differences in individual characteristics, clinical presentation and sonographic appearance between patients with adnexal masses managed surgically and those managed expectantly, and to state the different lines of management of adnexal masses practiced in Assiut University hospital. A cross sectional prospective study was conducted at Assiut University Hospital, Egypt between October 2012 and September 2013 included all patients presented with an adnexal mass which was detected either clinically or diagnosed by ultrasonography elsewhere. In conclusion, this study showed that Ultrasonography is the cornerstone in deciding the optimum modality of management of adnexal masses. Surgical intervention through laparotomy was the most common modality of management practiced in Assiut University hospital, while expectant management was offered for certain benign looking masses under strict follow up.