Amirbekian S, Hooley RJ. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. In children, is there an ovarian size (volume) that rules out torsion?” In the Journal of Pediatric Radiology , Servaes et al. Radiographics. Journal of clinical ultrasound : JCU. J Ultrasound Med. 1985;154 (3): 773-5. 1991;173 (5): 363-6. Radiol. Sonographic features include. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). Dähnert W. Radiology Review Manual. If surgical intervention is delayed, torsion can lead to vascular compromise of the affected ovary, resulting in hemorrhagic infarction . 15. Uterine adnexal torsion: sonographic findings. Radiographics. Clin. 1 Department of Radiology, Children's Hospital Boston, Boston, MA, USA. Duigenan S, Oliva E, Lee SI. Clin. 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" Ovarian torsion: CT and MR imaging appearances. Symptoms typically include pelvic pain on one side. ovarian torsion, which nevertheless is unlikely to be of clinical sig-nificance in differentiating torsion from other causes of acute pain in women. 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. 4. 212(1):5-18. . Cornfeld D, Scoutt L (2007) Torsion of a hyperstimulated ovary Reduction of ovarian torsion 1 week after embryo transfer in a patient during pregnancy: a potentially difficult diagnosis. In 75.0% (15/20) of cases and 65.0% (13/20) of controls, CT was performed prior to US. In this article, we discuss and illustrate the normal appearance and arterial flow … 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. 3. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. Bider D, Mashiach S, Dulitzky M et-al. Pathophysiology, clinical Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. 4. Mayumi Takeuchi, Kenji Matsuzaki, Masafumi Harada, Susceptibility-weighted MR sequence for the evaluation of ovarian masses with torsion, The British Journal of Radiology, 10.1259/bjr.20200110, (20200110), (2020). AJR Am J Roentgenol. Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. Unable to process the form. 11. Mortality resulting from ovarian torsion is rare. It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. 2012;198 (2): W122-31. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Approximately 20% of the cases occur during pregnancy 1. Sibal M, Sibal. Mosby Inc. (2003) ISBN:0323023282. (2008) RadioGraphics. 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. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Albayram F, Hamper UM. Sonogr… 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. Hannah C. Chang, Shweta Bhatt, Vikram S. Dogra. 1999 Jul. 28 (5): 1355-68. CT and MR imaging features of adnexal torsion. Douglas Rogers, Ragheed Al-Dulaimi, Maryam Rezvani, Anne Kennedy, Akram Shaaban, Peripheral hypervascularity of the corpus luteum with ovarian edema (CLOE) may decrease false positive diagnoses of ovarian torsion, Abdominal Radiology, 10.1007/s00261-019-02091-3, (2019). The final decision to ignore, follow or excise a cystic ovarian lesion is based on: Morphology of the lesion on US, CT or MRI ; Risk group (low versus high) Symptomatic lesion versus incidental finding ; Additional findings such as ascites, lymphadenopathy or peritoneal implants; That said, the great majority of cystic ovarian lesions is benign. CT features of adnexal torsion. 14. Warner MA, Fleischer AC, Edell SL et-al. 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. Uterine adnexal torsion: sonographic findings. J Ultrasound Med. Dähnert W. Radiology Review Manual. 2. [email protected]; PMID: 17357806 DOI: 10.1007/s00247-007-0429-x Abstract Background: The clinical diagnosis of ovarian torsion is challenging and findings on pelvic sonography … Spontaneous detorsion has also been reported. 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. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":9540,"mcqUrl":"https://radiopaedia.org/articles/ovarian-torsion/questions/1909?lang=us"}. Title: Ovarian Torsion Speakers: Dr. Maitray Patel Professor of Radiology Mayo Clinic Hospital The sensitivity of the individual signs ranged from 36.2% to 85.1%, and the specificity ranged from 18.8% to 87.5%. 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. Ultrasound is the initial imaging modality of choice. 2014;52 (6): 1215-1235. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. 7. Unable to process the form. J Ultrasound Med. There is an adnexal tenderness. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. However, rendering an accurate diagnosis of ovarian torsion is challenging. 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. The … There is an adnexal tenderness. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. (2012) Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Ultrasound Evaluation of Pelvic Pain. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Check for errors and try again. -. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. J Ultrasound Med. (2012) Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Not the imaging modality of choice if torsion is suspected, as urgent imaging is required. 8 Ultrasound whirlpool sign in ovarian torsion. 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 this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian to… The ovary and fallopian tube are typically involved. 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. With early diagnosis and appropriate treatment, the prognosis of ovarian torsion is excellent. On ultrasound hemorrhagic ovarian cyst presents as an unilocular thin-walled cyst with fibrin-strands or low-level echoes and good through transmission. Hannah C. Chang, Shweta Bhatt, Vikram S. Dogra. US findings, including 340 #{149} Radiology diameter) portion ovarian torsion with depiction of enlarged ovaries that have no documentable perfusion in parenchyma (2-4). Pearls and Pitfalls in Diagnosis of Ovarian Torsion. Radiol. CT features of adnexal torsion. 2007;189 (1): 124-9. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. Radiology. Torsion of a normal ovary more commonly occurs in young children when developmental abnormalities predispose the ovary to torsions, such as excessively long Fallopian tubes or an absent mesosalpinx. 1991;173 (5): 363-6. 2012;198 (2): W122-31. North Am. Ultrasound is the initial imaging modality of choice. In adulthood, causes include both benign and malignant ovarian tumours, polycystic ovaries and adhesions. 2002;20 (10): 1083-9. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. 2007;189 (1): 124-9. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Hubsta Ltd. (2007) ISBN:0781766206. The other was a third year radiology resident (D.W.S. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. - Adnexal torsion is more accurate than ovarian torsion. The MRI exam allows a comprehensive ovarian and other pelvic structure evaluation for pre surgical planning, particularly if there is a high degree of concern of ovarian torsion persists. In early pregnancy, a torsion can occur secondary to a corpus luteal cyst or laxity of the adjacent tissues. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. AJR Am J Roentgenol. Ultrasound is the initial imaging modality of choice. Sonogr… 14. 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. Ovarian torsion refers to complete or partial twisting of the vascular pedicle in the suspensory ligament, leading to obstructed lymphatic flow followed by obstructed venous flow and finally obstructed arterial flow. Torsion of a normal ovary more commonly occurs in young children when developmental abnormalities predispose the ovary to torsions, such as excessively long Fallopian tubes or an absent mesosalpinx. Sonogr… AJR Am J Roentgenol. Ultrasound is the initial imaging modality of choice. 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. AJR Am J Roentgenol. - Twisting of the vascular pedicle (ovarian branches of uterine artery), fallopian tube, or both could result in ischaemia and haemorrhagic infarction. 2. 8. Mortality resulting from ovarian torsion is rare. Amirbekian S, Hooley RJ. Adnexal torsion includes ovarian torsion, fallopian tube torsion, or both (67% of cases). 1994;190 (2): 337-41. 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. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. 8. 7. North Am. 28 (5): 1355-68. -. When a Graafian follicle or follicular cyst bleeds, a complex hemorrhagic ovarian cyst (HOC) is formed. Radiology. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. Ovarian torsion is usually associated with a cyst or tumour, which is typically benign; the most common being the mature cystic teratoma [7]. Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. 9. FIGURE 43A FIGURE 43B FIGURE 43C FINDINGS Figure 43A: Longitudinal and transverse grayscale US images show an enlarged left ovary (between cursors) with peripheral follicles. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. 1985;154 (3): 773-5. Sibal M, Sibal. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. (2008) RadioGraphics. Mosby Inc. (2003) ISBN:0323023282. Kimura I, Togashi K, Kawakami S et-al. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. 13. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. If hemorrhagic infarction is present, signal changes include 4: Urgent surgery is required to prevent ovarian necrosis. Sonographic features include. 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