Pearls and Pitfalls in Diagnosis of Ovarian Torsion

Abstract

Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. US features of ovarian torsion include a unilateral enlarged ovary, uniform peripheral cystic structures, a coexistent mass within the affected ovary, free pelvic fluid, lack of arterial or venous flow, and a twisted vascular pedicle. The presence of flow at color Doppler imaging does not allow exclusion of torsion but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of flow in the twisted vascular pedicle may indicate that the ovary is not viable. The role of computed tomography (CT) has expanded, and it is increasingly used in evaluation of abdominal pain. Common CT features of ovarian torsion include an enlarged ovary, uterine deviation to the twisted side, smooth wall thickening of the twisted adnexal cystic mass, fallopian tube thickening, peripheral cystic structures, and ascites. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary-sparing treatment.

Preoperative Magnetic Resonance Imaging Diagnosis of Ovarian Torsion

“…These include ovarian enlargement, twisted pedicle, ovarian hemorrhage, ascites, deviation of the uterus to the side with the twist, and fallopian tube thickening (6)(7)(8)(9). Among these, the present results indicate that identifying a twisted pedicle was the most useful characteristic for the diagnosis of ovarian torsion.…”

“…All other imaging findings are indirect and exhibit large degrees of overlap with other differential diagnoses. It is well known that several other conditions resulting in enlarged ovaries can mimic ovarian torsion, such as serous cystadenoma, polycystic ovary, or ovarian hyperstimulation syndrome (7). Indeed, hemorrhagic ovarian cysts have been referred to as "the great imitator" because of their various appearances, which depends upon the age of the blood product at the time (15).…”

“…Over the recent years, alternative techniques, such as computer tomography (CT) and magnetic resonance (MR) imaging, have become more frequently accepted in the diagnosis of ovarian torsion, particularly in subacute cases (4)(5)(6). Existing literature indicate that a number of different characteristic findings such as ovarian enlargement, twisted pedicle, ovarian hemorrhage, abnormal ovarian enhancement, ascites, deviation of uterus to the twisted side, and thickening of the fallopian tube are associated with ovarian torsion (6)(7)(8)(9). Our literature search did not unearth any previous studies that assessed the diagnostic performance of preoperative MR imaging for the diagnosis of ovarian torsion.…”

Histopathologic spectrum of cystic ovarian masses

“…Among benign tumors, mature cystic teratomas are the most commonly affected. 17 We found 14.9% of all ovarian cysts to have undergone torsion. 14.8% of adnexal tumors had undergone torsion in a study carried out in Tunisia.…”

Akut Abdomen

“…Kronik olgularda infarkta bağlı kistik ya da hemorajik dejenerasyon gö-rülebilir. Serbest sıvı ve overde kitle görülebilir (Şekil 3A) [14].…”