Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. All the patients who failed to show blood flow within the twisted vascular pedicle showed hemorrhagic infarction and necrosis of the adnexal structures. Twist and Shout! Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. 2010;36:630-4. She denied any lightheadedness, syncope, weakness, or dizziness. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature. Pediatr. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. In conclusion, the positive whirlpool sign in the twisted vascular pedicle is the most definitive sign of ovarian torsion. Blood flow in the twisted vessels is not seen in all patients. Duigenan S, Oliva E, Lee SI. The ovary had features of gangrene or impending gangrene in all 8 patients in whom flow was not seen in the vessels of the pedicle and in 1 of the 2 patients in whom there was flow only in the proximal part of the pedicle. Identifying Ovarian Torsion on Ultrasound. sudden onset, similar to her prior ovarian torsion. The purpose of this study was to describe an additional maneuver during sonography and to assess its diagnostic value in ovarian torsion. A round mass, suggestive of a twisted pedicle, was seen in all 21 patients. Though absence of arterial flow is classically described as the color Doppler sonographic finding in ovarian torsion, this is reported in only 73% of cases . If not treated quickly, it can result in loss of an ovary. Obstetrics & Gynecology International Journal. Please check your email for instructions on resetting your password. Ultrasound of Pelvic Pain in the Nonpregnant Woman. Lee et al11 also reported 94% predictability of the viability of the ovary when arterial and venous flow was seen in the twisted pedicle. In a stable patient who is suspected of having acute abdomen what is the next best course of action? Gynecologic Emergencies: Findings Beyond US and Advances in Management. Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axis, resulting in arterial, venous, or lymphatic obstruction. Twenty patients underwent surgery 4 to 36 hours after the scans. The gray scale features of the ovarian mass were recorded. Point-of-Care Pelvic Ultrasonography in Emergency Medicine. Journal of Pediatric and Adolescent Gynecology. 31 Tepper R, Zalel Y, Goldberger S, Cohen I, Markov S, Beyth Y. Case Report: Ovarian Torsion in Pregnancy – Diagnosis and Management. 70 PubMed TI Sonographic whirlpool sign in ovarian torsion. The twisted vascular pedicle corresponds to the broad ligament, fallopian tube, and adnexal and ovarian branches of the uterine artery and vein.11 Lee et al11 reported that a false‐positive diagnosis could be made in cases of ovarian tumor‐associated salpingitis, endometriosis, or hemorrhagic cyst–associated edema because these conditions could have findings similar to those of a twisted vascular pedicle. The last patient was pregnant and did well with conservative treatment. Ghonge NP, Lall C, Aggarwal B, Bhargava P. Clinical symptoms and signs of ovarian torsion are often nonspecific, and imaging studies have a crucial role in making an accurate timely diagnosis. No flow was seen in the vessels (Figure 5B) of the pedicle in 8 patients. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Ovarian torsion: Opportunities to improve clinical management. Vijayaraghavan SB. Imaging Diagnosis of Right Lower Quadrant Pain in Children. Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation. It had the appearance of a snail shell (Figure 3A) in 2 patients. Gynecological pelvic pain as emergency pathology. This sign is important because the cross section of the twisted pedicle has 4 different appearances, some of them mimicking other conditions. It appears as twisting of the thickened vascular pedicle of the enlarged ovary. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion. Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-Conservative Treatment and Literature Analysis. The diagnosis was surgically confirmed in all 20 patients who underwent surgery. Conclusions. There was an enlarged ovary with peripheral cysts suggestive of ovarian torsion in 5. On MRI, it is best demonstrated on axial T2 and T1 C+ fat sat sequences 1. In this article, we discuss and illustrate the normal appearance and arterial flow … Recent reports have suggested that documentation of intraovarian venous flow is important in establishing the viability of the affected ovary.3 Lee et al11 performed a color Doppler study on the twisted vascular pedicle instead of the ovarian parenchyma to assess the viability of the ovary in torsion. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. Common ultrasound signs are an enlarged organ, the "whirlpool sign", and "ovarian stromal edema with or without peripherally displaced antral follicles", and free fluid in the pel … Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Sonographic and MRI features of ovarian torsion. However, the whirlpool sign was seen in all of them. Pathologic diagnosis of the ovarian masses in the 19 patients in whom the ovarian mass was removed included teratoma in 6, serous cystadenoma in 4, mucinous cystadenoma in 2, a luteal cyst in 3, fibroma in 1, and hemorrhagic necrosis of the ovary in 2. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. They were investigated with gray scale and color Doppler sonography. Ultrasonography findings suggestive of ovarian torsion include unilateral ovarian enlargement, ovarian edema characterized by the presence of a hyperechogenic ovary with peripherally displaced follicles and echogenic stroma, free fluid, and a coiled vascular pedicle (referred to as the “whirlpool sign”) 17 Figure 2. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use. The same procedure was repeated on a color Doppler study. 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" Most common finding is an enlarged ovary or adnexal mass. A and B, Two types of target appearances of the twisted vascular pedicle (arrows). Adnexal torsion — A multimodality imaging review. Not considered appropriate in children; abdominal ultrasound is recommended. In the fifth, the ovary was enlarged and appeared viable. During a period of about 2 years 6 months, there were 21 patients with lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography. 2012;198 (2): W122-31. Imaging of Gynecological Disorders in Infants and Children. AJR Am J Roentgenol. A palpable pelvic mass was reported in 10 patients, and it was found to be tender in 5. ?88% of patients with ovarian torsion [2, 10, 12]. Tératomes ovariens matures et immatures : caractéristiques en échographie, TDM et IRM. The patients selected for study were female patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography. • Ovarian torsion 4. In the whirlpool sign, the hypoechoic band in the twisted pedicle, representing the vessels, was seen wrapping around the central axis. Learn more. Acute abdominal distension in early pregnancy from torted ovarian serous cystadenoma. (2004) Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. The gray scale features of the ovarian mass were recorded. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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