8 Ultrasound whirlpool sign in ovarian torsion. 8. 13. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Common CT findings of ovarian torsion are somewhat nonspecific and include an adnexal mass that may be in the midline or rotated toward the contralateral side of the pelvis, deviation of the uterus to the side of the affected ovary, and ascites [6, 8]. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. This article presents 12 cases of pathologically confirmed … Most ovaries are not salvageable, in which case a salpingo-oophorectomy is required. Radiol. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. AJR Am J Roentgenol. (2008) RadioGraphics. Ovarian torsion is a possible cause of acute abdominal pain in women at any age, especially during their reproductive years [1,2]. 2002;20 (10): 1083-9. For an enlarged oedematous ovary +/- Fallopian tube, consider: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The result of vascular compromise secondary to ovarian torsion is hemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset. Chiou SY, Lev-toaff AS, Masuda E et-al. Because ovarian torsion is often unsuspected in women undergoing CT or MRI for pelvic pain, the radiologist plays an important role in patient triage by raising ovarian torsion as a diagnostic consideration. Case 11: twisted pedicle on CT with whirl sign, Case 26: incomplete with fallopian tube torsion- paratubal cyst, abnormal endometrial thickness (differential), large cystic ovaries undergoing ovarian hyperstimulation are at particular risk, variable echogenicity (hypo- or hyperechoic), a long-standing infarcted ovary may have a more complex appearance with cystic or haemorrhagic degeneration, peripherally displaced follicles with hyperechoic central stroma, free pelvic fluid may be seen in >80% of cases, an underlying ovarian lesion may be seen (possible lead point for torsion), Doppler findings in torsion are widely variable, little or no ovarian venous flow (common; sensitivity of 100% and specificity of 97%), absent arterial flow (a less common, sign of poor prognosis), normal vascularity does not rule out intermittent torsion, normal Doppler flow can also occasionally be found due to dual supply from both the ovarian and uterine arteries, good at ruling out ovarian torsion if a normal ovary/adnexa is seen on ultrasound, the twisted ovarian pedicle is pathognomonic for ovarian torsion if demonstrated, torsion appears as a complex adnexal lesion representing, HU >50 on non-contrast CT suggests haemorrhagic necrosis, surrounding fat stranding, oedema, and free fluid, thin rim of high signal (methaemoglobin) without contrast enhancement, the ovary should be tender to transducer pressure, absence of ovarian Doppler flow is highly specific for torsion, but normal Doppler flow does not completely rule out torsion, an ovarian mass causing the torsion must always be sought, 1. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. AJR Am J Roentgenol. Clin. Radiology. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. 2007;26 (10): 1289-301. 4. Kimura I, Togashi K, Kawakami S et-al. Radiology. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. 3. Other symptoms may include nausea. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, oedema, and haemorrhage. In which case a salpingo-oophorectomy is required to prevent ovarian necrosis of diagnostic imaging in %!: Radiopaedia is free thanks to our supporters and advertisers restoration of blood in! Spectrum of sonographic findings with pathologic correlation imaging observations by sonography, computed,... 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