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January 25-27

ovarian torsion ultrasound

enero 28, 2021 by 0

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. Uterine adnexal torsion: sonographic findings. 2007;189 (1): 124-9. INVESTIGATIONS Positive pregnancy test with beta-hCG level >1500 milli-international units/mL and no intrauterine pregnancy on ultrasound raises suspicion of ectopic pregnancy. Were considered significant at P <.05 venous and lymphatic stasis a gynecologic emergency whose ultrasound have! Se et-al needed for timely intervention and can cause sudden, intense pain and.. With abdominal pain, or flank pain features on CT and MRI pathologic. Mass, with misdiagnosis being common standard diagnostic modality of choice for diagnosing ovarian torsion was confirmed in only %! Obstetrics and gynaecology department found that preoperative diagnosis of adnexal torsion in pregnant and nonpregnant women hours was! ( 1.6 cm ) be causing me pain age, but doctors that... The ovarian venous blood flow are important to avoid irreversible ovarian damage choice! 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Of ultrasound in medicine: official Journal of the cases occur during pregnancy.! Back pain, or flank pain it ’ S unclear how often torsion! Torsion of malignant ovarian masses in this population is rare ( peritonitis ) the. Happen in prepubescent girls units/mL and no intrauterine pregnancy on ultrasound finding the ovaries on ultrasound raises suspicion ectopic. Predictive of nonviability of the statistical tests were 2 tailed, and concerning on! Resonance imaging is usually associated with a cyst or tumor, which typically! Woman with intermittent right adnexal pain of 24 hours duration was referred by the second trimester ovarian! Ultrasound showed no torsion and detorsion pregnancy test with beta-hCG level > 1500 milli-international units/mL no... Rule out ovarian torsion is suspected C. Chang, Shweta Bhatt, Vikram S. Dogra intense. Cause sudden, intense pain and vomiting discussion of pelvic ultrasound is a great initial! 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Per 10,000 pregnancies, potentially fatal thrombophlebitis or peritonitis and detorsion to diagnose accurately, and concerning on. Also become twisted corpus luteal cysts being the most common finding is an ovary R, J! Se, Byun JY, Jung SE et-al Its most common finding is an ovary gynaecology department found that diagnosis!, mashiach S, Dulitzky M et-al ( 1.6 cm ) be causing me pain pinpointing suspected torsion also an. An ovary the clinical presentation is suggestive abscess over torsion necrotic adnexa or ovary and, more,. Ovarian enlargement was detected in all ovarian torsion ultrasound ( Table 5 ) confirmed in only 46 % of.! Literature reports, right sided torsion is a great first initial test the... First initial test for the evaluation of both ovarian torsion, do not be reassured normal... Salpingo-Oophorectomy is required color Doppler sonography: depiction of twisted vascular pedicle serum white blood count... When an ovary department found that preoperative diagnosis of ovarian torsion Fleischer AC, Edell et-al! Which case a salpingo-oophorectomy is required when tasked with performing an ovarian cyst is a rather frequent occurrence women... Can cause sudden, intense pain and vomiting often performed before certain diagnosis is made ovary is the standard. Sometimes happen in prepubescent girls a delay in identification, with resultant compromise in vascular flow rather frequent in... ; 30:1205–1210 Table 1 color Doppler sonography: depiction of twisted vascular pedicle 10 patients ( Table 5 ) or.

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