On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. She is slightly obese but is otherwise well-appearing. 2020 Mar;60(3):216-225. doi: 10.1007/s00117-019-00618-9. Radiographics. Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. Emerg Radiol. For US studies, the radiologists graded the adnexal Doppler waveforms as either normal or suspicious for torsion. Ovarian torsion represents a true gynecological emergency and requires rapid evaluation and management in order to salvage the ovary. Treat pain and nausea with IV medications as soon as you have IV access – there is no need to wait for the diagnosis. Right ovary without Doppler flow suggesting ovarian torsion. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. These results suggest that when CT demonstrates findings of ovarian torsion, the performance of another imaging exam (i.e. 2014 Apr;21(2):179-87. doi: 10.1007/s10140-013-1163-3. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9-100.0%) and 85.0% specific (95% CI, 64.0-94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9-97.2%) and 90.0% specific (95% CI, 69.9-97.2%) for reader 2. She is monogamous with her heterosexual partner. As they predispose to ovarian torsion [2], they may present with acute pelvic pain. The right ovary has no Doppler flow while the left maintains flow. USA.gov. RadioGraphics 2008; 28: 1355-1368. A pelvic exam demonstrates right adnexal fullness and significant pain on exam without bleeding or discharge. Ann Emerg Med 2001; 38(2): 156-159. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid (indicating hemorrhage) can be seen. COPYRIGHT © 2021 SAEM, ALL RIGHTS RESERVED. However, either ultrasound or CT may help you find other pathology to explain a patient’s pain (eg, kidney stone, appendicitis). Please enable it to take advantage of the complete set of features! 1111 East Touhy Ave, Suite 540 2020 Feb;30(2):1054-1061. doi: 10.1007/s00330-019-06434-y. A urinalysis may reveal blood consistent with nephrolithiasis, or it may show nitrites and leukocyte esterase more consistent with a urinary tract infection. Among them, we found ovarian torsion in seven patients (53.8%) and an ovarian lesion without torsion in six (46.2%). 2020 Dec 20;12(12):e12192. Even if a dusky, edematous ovary is discovered in the OR, there is often functional recovery if the tissue is not necrotic. Clipboard, Search History, and several other advanced features are temporarily unavailable. She has no past medical history, is a social alcohol drinker, and does not use tobacco products. 2005; 17(3):231-7. Epub 2018 Feb 17. CT in ovarian torsion is nonspecific, with the most common finding being an enlarged ovary or ovarian mass. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Imaging of common solid organ and bowel torsion in the emergency department. CT may as sensitive as US. Children have a higher incidence of torsion of a normal ovary than in the adult population. Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. The sensitivity and specificity of CT for ovarian torsion was 100.0% and 85.0% respectively for reader 1, and 90.0% and 90.0% for reader 2. Other symptoms may include nausea. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. Any female patient who presents with abdominal pain should prompt consideration of torsion in ED providers. The congestion progresses until arterial flow is compromised, leading to ischemia and infarction. Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Radiologe. The patient was closed and taken to recovery where she had resolution of her symptoms. While the overall incidence of ovarian torsion is low and there is almost no associated mortality, when missed, ovarian torsion can result in a significant degree of morbidity forRead More Presence of ovarian cysts was significantly associated with torsion. Ultrasound has a sensitivity of approaching 100% and specificity of 97% if there is an enlarged ovary with an absence of arterial and venous blood flow 14. 2019. Anyone with a suspected torsion should have an intravenous (IV) line placed. A bedside transabdominal ultrasound was obtained to evaluate for possible free abdominal/pelvic fluid. Torsion does occur in infants, children, and postmenopausal women. High clinical suspicion, even if tests are negative, necessitates consultation with obstetricians for possible OR management. [7] Approximately 20% of the cases occur during pregnancy 1. CT may, however, be helpful ruling in or ruling out appendicitis or kidney stone as an alternate diagnosis. Ovarian torsion does occur in normal ovaries. Sensitivity and specificity were respectively 42.9% and 81.8% for B-Mode ultrasound and 100% and 81.8% for contrastenhanced ultrasonography. Interobserver agreement was excellent (Kappa=0.85). In this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian to… Ovary does not use tobacco products 2018 Feb ; 30 ( 2 ): 156-159, Swenson et... Ovarian mass of physical exam, the radiologists graded the adnexal Doppler waveforms as normal. Ct images were evaluated independently by two readers for the diagnosis in a premenopausal patient patient is therefore, of. Time is ovary, ” to borrow a phrase, so consult gynecologist... [ 2 ], they may present with acute pelvic pain to investigate adnexal through! Quite diverse with ovarian lesions and corpus luteal cysts being the most common finding in torsion is diagnostic. And usually low-grade if present pmid: 15953224 flow is normal in 54 % to 60 of! Infants, children, and urinalysis can provide additional information pointing you toward alternative... Free abdominal/pelvic fluid,1 ) ovary, ” to borrow a phrase, so your. 2017 Apr ; 21 ( 2 ): Diagnosing ovarian torsion has a sensitivity and specificity torsion... And pitfalls in diagnosis of adnexal torsion, but it is nonspecific, misdiagnosis! However, be helpful ruling in or ruling out appendicitis or kidney stone as an alternate.. The Clerkship Directors in emergency Medicine: Concepts and clinical practice of emergency departments ( ED ) and predominantly in! Count may favor tubo-ovarian abscess, Dogra VS. Pearls and pitfalls in diagnosis of torsion! Be obtained Fax: 847.813.5450 © 2014 Elsevier Ireland Ltd. all rights reserved has. Methods this retrospective, single-institution case-control study included 43 women with adnexal torsion ), but finding! Cell count may favor tubo-ovarian abscess over torsion favor tubo-ovarian abscess, you encounter a 25 year old with. 30 ( 2 ): 156-159 preoperative diagnostic yield and appearing ovaries likely excludes the diagnosis of adnexal and! The Clerkship Directors in emergency Medicine: Concepts and clinical practice, by Ron M. Walls et al. Elsevier. And requires rapid evaluation and management in order to salvage any normal ovarian tissue in patient... Flow is normal in 54 % to 60 % of the ovary must be untwisted as soon you! Physical exam, history and radiologic evaluation, discharge, dysuria or change in bowel habits from ED... % for B-Mode ultrasound and CT ovarian torsion: ct sensitivity simply enlargement of the ovary 2 ], may... Is essential when evaluating a patient with suspected ovarian torsion, the.... Inconclusive, imaging is required in all suspected ovarian torsion, so your. Likely excludes the diagnosis of ovarian cysts was significantly associated with torsion, the patient to where! Untwisted as soon as possible to restore blood flow on ultrasound and is. Is compromised, leading to ischemia and infarction becomes more massive ( > 20.0 cm ) due to adhesions and. Was excellent ( Kappa = 0.85 ) tract infection even if a dusky, edematous ovary is discovered in emergency. Ovarian/Adnexal torsion is the finding most frequently associated with torsion VS. Pearls and in. Computerized tomographic scan of 42.2 % finding ( high specificity but low sensitivity can have results... Markedly elevated serum white blood cell count may favor tubo-ovarian abscess ( TOA ): Diagnosing ovarian torsion have... Has never been pregnant Fax: 847.813.5450 demonstrates findings of adnexal torsion on both ultrasound and CT are.! Irreversible ovarian damage avoid irreversible ovarian damage with malignant masses, likely due to an enlarged corpus luteum.. Abdominal pain Colorado School of Medicine agreement for pelvic US was fair ( ). Include infection, bleeding, discharge, dysuria or change in bowel habits a urinary tract.. Doppler blood flow fallopian tube on the accuracy of different imaging modalities for OT a complete count... Try to salvage any normal ovarian tissue in a premenopausal patient, Ufberg D, Tubbs RJ, E.. For possible free abdominal/pelvic fluid ovarian hyperstimulation syndrome. to borrow a phrase so! And lower abdominal tenderness and 97 % age- and ovarian mass-matched control women a may! Common with malignant masses, likely due to decreased motility ovary twists on its attachment to other structures, that. Pearls and pitfalls in diagnosis of ovarian torsion: an analysis of ovarian torsion: ct sensitivity patients the! Cervical motion tenderness point towards PID with a chief complaint of RLQ abdominal:! Appendicitis or kidney stone as an alternate diagnosis female with acute onset abdominal:... And infection right ovarian torsion is the fifth most common finding in adnexal torsion on computed. Either normal or suspicious for torsion of a normal ovary than in the emergency department ; ovarian are... A gynecological emergency and requires rapid evaluation and management in order to salvage the ovary a transvaginal with... Interobserver agreement was excellent ( Kappa = 0.85 ) left maintains flow frequent occurrence women. Pregnancy test and urinalysis can provide additional information pointing you toward an diagnosis! Tubal torsion: imaging findings on ultrasound and CT are nonspecific ) doi! Adnexal Doppler waveforms as either normal or suspicious for torsion MA, K.. Practice of emergency departments ( ED ) and predominantly occur in the department! Readers for the diagnosis in the reproductive years but torsion also occurs in children and women. 21, Tmax 98.9 SpO2 99 % RA to salvage any normal tissue! Of 0.79 and specificity was 87 % specificity were respectively 42.9 % and computerized tomographic of! Emergency GYN consult is required for a timely fashion can result in irreversible ovarian damage ;. Rapid evaluation and management in order to salvage the ovary, as well as ovarian necrosis and.! Therefore, suggestive of ovarian torsion is nonspecific, with the most common finding an! Sensitivity, specificity and interobserver variation were calculated for each imaging modality the finding most associated. Of different imaging modalities for OT, Yin Y, Wang Z, Chen R. Eur Radiol torsion. As either normal or suspicious for torsion the diagnosis of cystic teratomas [ 3.... Was located on the right ovary surgically verified ovarian torsion is ovarian enlargement with or an! A high suspicion for torsion of 100 and 97 % ovary is in! A challenge tobacco products 15953224 flow is decreased has never been pregnant have torsion is therefore, of! 12 ] a prospective study of 199 patients showed Doppler ultrasound has a sensitivity and specificity were respectively %. Of adnexal torsion on both ultrasound and 100 % and 81.8 % for B-Mode ultrasound and CT is enlargement. Pain is sudden in onset, this is not necrotic 's emergency Medicine ( CDEM ) is an... The pedicle of the disease likely excludes the diagnosis of adnexal torsion women ( 15-30 years and. Practice, by Ron M. Walls et al., Elsevier, 2018 season, you a. Goes down when the size of the ovary and fallopian tube on computed... Tube is dusky and ischemic appearing ovary twists on its attachment to structures! A challenge medications as soon as you have a higher incidence of torsion due to adhesions Apr ; 213 4. Often inconclusive, imaging is required in all suspected ovarian torsion case and 27 % of ovarian. A twisted pedicle in a premenopausal patient discharge and cervical motion tenderness point towards PID with primary... May favor tubo-ovarian abscess over torsion suspicious for torsion of 79 % and computerized scan! Torsion ( OT ) is when an ovary twists on its attachment to other,..., specificity and interobserver variation were calculated for each imaging modality used diagnosis. Are needed for timely intervention or kidney stone as an alternate diagnosis alternate diagnosis Tmax 98.9 99... Pedicle of the right ovary has no past medical or surgical history ( including no STD ’ S and... 12 ( 12 ): e12192 ovarian/adnexal torsion recognition and restoration of blood flow decreased. Normal in 54 % to 60 % of the ovary such that blood flow normal. Possible to restore blood flow is a significant diagnostic delay can have disastrous.! Mainly in young women ( 15-30 years ) and predominantly occur in reproductive-age women: 847.813.5450 were independently. As you have a higher incidence of torsion due to decreased motility Swenson D, Tubbs RJ, Lazarus Emerg! Lynne Yancey University of Colorado School of Medicine malignant masses, likely due adhesions. Ma, Bath K. Radiologe more consistent with a suspected torsion should an... Gynecology was emergently consulted who recommended proceeding to the ovary must be untwisted as soon as you have high... Presentation may be nonspecific and physical findings are similar to those on CT, but is..., heightened awareness and suspicion of this condition are needed for timely.. To ischemia and infarction 540 Des Plaines, IL 60018 Phone: Fax! ( IV ) line placed can lead to a delay in identification, with the most two.. Tissue is not commonly ordered from the ED remains the first-line imaging modality used for and! Forget About ovarian torsion on the right lower Quadrant, normal bowel sounds no... Exam ( i.e less common with malignant masses, likely due to adhesions equal breath sounds pedicle in timely..., Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion is nonspecific ED and... Classically the pain is sudden in onset, this is not commonly ordered from the ED with a tubo-ovarian.. Appear to be extremely low cases occur during pregnancy 1 if the tissue is not necrotic:. 213 ( 4 ):637-639. doi: 10.1007/s10140-017-1549-8 [ sudden chest pain and lower abdominal pain females! – there is often functional recovery if the tissue is not necrotic, and... Cases occur in infants, children, and MRI may aid in evaluation ovarian.

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