Sertoli-Leydig cell tumor (SLCT) of the ovary is an exceedingly unusual neoplasm that belongs to a group of sex cord‑stromal tumors of the ovary and accounts for less than 0.5% of all primary ovarian neoplasms. We present a case of primary ovarian SLCT in a 21‑year‑old female who presented with a 6‑month history of pelvic pain, acne, hirsuitism and oligomenorrhea with elevated testosterone and dehydroepiandrosterone levels. Ultrasound and contrast computed tomography revealed a well‑defined hypervascular heterogeneous solid lesion in the left adnexa. Magnetic resonance imaging demonstrated an ovarian origin of the tumor, which indicated an SLCT on histopathology. In this case, we discuss the multimodality imaging findings of SLCT and its management aspects with a review of the literature.