J Ultrasound Med. CT features of adnexal torsion. It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. A quick and confident diagnosis is … In adulthood, causes include both benign and malignant ovarian tumours, polycystic ovaries and adhesions. 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. In early pregnancy, a torsion can occur secondary to a corpus luteal cyst or laxity of the adjacent tissues. Ovarian torsion: CT and MR imaging appearances. servaes@email.chop.edu; PMID: 17357806 DOI: 10.1007/s00247-007-0429-x Abstract Background: The clinical diagnosis of ovarian torsion is challenging and findings on pelvic sonography … Bider D, Mashiach S, Dulitzky M et-al. AJR Am J Roentgenol. 1994;190 (2): 337-41. The sensitivity of the individual signs ranged from 36.2% to 85.1%, and the specificity ranged from 18.8% to 87.5%. 28 (5): 1355-68. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. US findings, including 340 #{149} Radiology diameter) portion ovarian torsion with depiction of enlarged ovaries that have no documentable perfusion in parenchyma (2-4). Figure 43B: Color Doppler sonogram of the left ovary… Accuracy of Isolated and Combined Sonographic Signs for Diagnosis of Ovarian Torsion Table 3 shows the accuracy of the various sonographic signs for diagnosis of ovarian torsion. 22 (2): 283-94. Ovarian torsion is usually associated with a cyst or tumour, which is typically benign; the most common being the mature cystic teratoma [7]. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Ultrasound is the initial imaging modality of choice. Torsion occurs due to two main reasons 2: Most patients present with severe non-specific lower abdominal and pelvic pain, either intermittent or sustained, nausea, and vomiting. Sibal M, Sibal. 15. Ultrasound is the initial imaging modality of choice. Unable to process the form. J Ultrasound Med. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. Ultrasound is the initial imaging modality of choice. Mosby Inc. (2003) ISBN:0323023282. Approximately 20% of the cases occur during pregnancy 1. Sonogr… characterization. However, rendering an accurate diagnosis of ovarian torsion is challenging. Symptoms typically include pelvic pain on one side. The other was a third year radiology resident (D.W.S. 2007;189 (1): 124-9. 3. In the case of a non-infarcted adnexa, surgical untwisting can be performed. Clin. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, oedema, and haemorrhage. 6. 2002;20 (10): 1083-9. (2008) RadioGraphics. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. -. There is an adnexal tenderness. However, heightened awareness and suspicion of this condition are needed for timely intervention. 1991;173 (5): 363-6. Ultrasound imaging, even if using color coded Doppler technique may be inconclusive, though an enlarged ovary in association with “whirlpool- sign” is diagnostic [3]. Warner MA, Fleischer AC, Edell SL et-al. Sonogr… Not the imaging modality of choice if torsion is suspected, as urgent imaging is required. Approximately 20% of the cases occur during pregnancy 1. 1 Department of Radiology, Children's Hospital Boston, Boston, MA, USA. Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. Journal of clinical ultrasound : JCU. J Ultrasound Med. 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 hemorrhagic 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 hemorrhagic necrosis, surrounding fat stranding, edema, and free fluid, thin rim of high signal (methemoglobin) 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. Chiou SY, Lev-toaff AS, Masuda E et-al. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. Dähnert W. Radiology Review Manual. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). Radiology. Not the imaging modality of choice if torsion is suspected, as urgent imaging is required. J Ultrasound Med. If haemorrhagic infarction is present, signal changes include 4: Urgent surgery is required to prevent ovarian necrosis. 2. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. ). Ultrasound is the initial imaging modality of choice. This article presents 12 cases of patholog-ically confirmed ovarian torsion diagnosed on CT or MRI. Kimura I, Togashi K, Kawakami S et-al. Spontaneous detorsion has also been reported. a, bColor flow on Doppler US images demonstrates the twisted pedicle (arrows) in a 12-year-old girl with a large, mature cystic teratoma (T) arising from the left adnexa, representing the lead point for left adnexal torsion - "Pediatric ovarian torsion: a pictorial review" Pelvic or intravaginal ultrasound remains the first-line imaging modality used for diagnosis and evaluation of suspected ovarian/adnexal torsion. 8 Ultrasound whirlpool sign in ovarian torsion. 6. The ovary and fallopian tube are typically involved. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. The … 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The result of vascular compromise secondary to ovarian torsion is haemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset. Ovarian torsion is a possible cause of acute abdominal pain in women at any age, especially during their reproductive years [1,2]. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Diffusion weighted imaging and gadolinium-enhanced fat-saturated breath-hold pulse sequences play a crucial role in improving the specificity of MR value in diagnosis of ovarian torsion. Journal of clinical ultrasound : JCU. Nizar K, Deutsch M, Filmer S et-al. Chiou SY, Lev-toaff AS, Masuda E et-al. Fertil Steril 76:403–406 14:331–335 3. Amirbekian S, Hooley RJ. Radiol. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. 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