Mortality resulting from ovarian torsion is rare. Complete arterial obstruction is unlikely due to the dual blood supply to the ovary from both the uterine and ovarian arteries. Ultrasound conclusions were compared to the final diagnosis observed during surgery or at the last follow-up for non-operated patients (Table 5). The derivation of a dermoid cyst. Conclusion: While ultrasound can be used to support a diagnosis of ovarian torsion, it is a clinical diagnosis that requires integration of many factors, especially patient presentation and exclusion of other non-gynaecological pathologies. In early pregnancy, a torsion can occur secondary to a corpus luteal cyst or laxity of the adjacent tissues. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Sibal M, Sibal. Ovarian torsion rarely presents with classic symptoms. Although ovarian torsion is not common, it is a medical emergency. 2. Always consider torsion when evaluating a female patient with abdominal pain, back pain, or flank pain. 2007;189 (1): 124-9. 4. ovarian torsion ultrasound A 33-year-old female asked: why would my small ovarian dermoid cyst (1.6 cm) be causing me pain? Lee EJ, Kwon HC, Joo HJ et-al. B-Mode ultrasound identified an ovarian torsion in 5 cases (27.8%) and the absence of torsion in 13 cases (72.2%). Approximately 20% of the cases occur during pregnancy 1. catalogued the ultrasound findings in children with surgically confirmed torsion over a 12 year period. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are … In early pregnancy, a torsion can occur secondary to a corpus luteal cyst or laxity of the adjacent tissues. Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. While US is a great first initial test for the evaluation of both ovarian torsion, do not be reassured by normal dopplers. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Caption: Sagittal image of the right ovary Description: Gray-scale sagittal image reveals right ovary to be enlarged (7 cm) with peripheral follicles and areas of increased echogenicity. 9. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. J Ultrasound Med. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. 8. Ultrasound findings described as predictors of torsion include adnexal location that is cranial to the uterine fundus, thickening of the adnexal wall, unilateral ovarian enlargement with multiple peripherally located follicles, and cystic haemorrhage. 22 (2): 283-94. 2012;198 (2): W122-31. 1991;173 (5): 363-6. 9. Chiou SY, Lev-toaff AS, Masuda E et-al. 4 Its most common cause in pregnancy is a corpus luteum cyst, which usually regresses spontaneously by the second trimester. 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. 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