Ovarian torsion

Furthermore, a large-scale of intraabdominal or extraabdominal disorders can cause acute abdominal pain. Intraabdominal causes may have a genitourinary (urinary tract infection, ovarian torsion) or biliopancreatic origin (colecistitis, pancreatitis, etc.). Extraabdominal causes include abdominal pain referred from non-abdominal organs (pneumonia, discitis) and abdominal pain related to a systemic disease, such as diabetic acidosis, hypothyroidism, lead metals poisoning, sickle cell anemia, and porphyria. Fortunately, these different causes... 

Pelviureteric junction obstruction Ovarian cyst Ovarian torsion Hydrometrocolpos... 

The main gynecological conditions causing acute abdominal pain are functional ovarian cysts, ovarian torsion, and hydrometrocolpos. Transabdominal US will commonly show the lesion. Transvaginal US should not be routinely done as a primary investigation in adolescent girls, but may supplement the abdominal examination in sexually active patients. 

Fig. 1.85a-e. Ovarian torsion. a,b Longitudinal US scan shows an echogenic mass with tiny cyst behind the uterus (U) in the cul-de-sac. The little prepuberal uterus is displaced anteriorly, and it is hard to delineate it from the mass (arrows), c Color Doppler showing the absence the flow in the center of the ovary, d Surgical specimen, e In vitro study of the ovary. Multiple edematous immature follicles maybe visualized in the ovary not only in the periphery but in the whole ovary. B, bladder... 

Gonzalez-Spinola J, del Pozo G, Tejedor D et al (1999) Intussusception the accuracy of ultrasound-guided saline enema and the usefulness of a delayed attempt at reduction. J Pediatr Surg 34 1016-1020 GraifM, ItzchakY (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol 150 647-651... 

Gynaecological disorders, such as ruptured ovarian cysts, ovarian torsion,ectopic pregnancy or pelvic inflammatory disease, can resemble acute diverticulitis in female patients, but often these patients are younger. Transvaginal sonography maybe helpful in obtaining an accurate diagnosis. Stone of the ureter on the left side may simulate diverticulitis. 

Ovarian torsion is most commonly associated with tubal torsion. Two age groups tend to be affected children and women in their first three decades, and postmenopausal women. 

Massive edema of the ovary is a rare disorder found in the second and third decades of life and considered a variant of ovarian torsion. It results from partial or intermittent torsion and is characterized by an excessively enlarged edematous ovary [10]. 

In adults, most commonly a mass with hyperin-tense signal on Tl and T2 due to hemorrhage has been described [16]. Smooth wall thickening of the twisted adnexal cystic mass and a thin hyperintense rim at the periphery of the lesion on Tl-weighted images are further signs in ovarian torsion. 

Clinically, ruptured ovarian cysts may resemble ovarian torsion. In a patient with acute pelvic pain, a hemorrhagic lesion within a normal size ovary is typically a ruptured ovarian cyst. Furthermore, unlike in most cases of ovarian torsion, clotted blood may be detected in the lesser pelvis. Wall edema of an adnexal mass, engorged adnexal vessels or dilatation of the fallopian tube are missing. TUboovarian abscess and hydrosalpinx may resemble advanced adnexal torsion. Lack of enhancement supports the diagnosis of ovarian torsion. In children, sonography usually allows the diagnosis of appendicitis as a cause of acute pelvic pain. In case of a suspected abscess or an ovarian mass, MRI may aid in further assessment of the adnexa. Rarely, a calcified mass may result from chronic infarction which cannot reliably be differentiated from a calcified ovarian tumor [19]. 

Lee EJ, Kwon HC, Joo HJ et al (1998) Diagnosis of ovarian torsion with color Doppler sonography depiction of twisted vascular pedicle. J Ultrasound Med 17 83-89... 

Graif M, Itzach Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol 150 647-649... 

Currarino G, Rutledge JC (1989) Ovarian torsion and amputation resulting in partially calcified, pedunculated cystic mass. Pediatr Radiol 19 395-399... 

In one case reported from Japan, there was torsion of an ovarian cyst (73). 

Nasu K, Miyazaki T, Kiyonaga Y, Kawasaki F, Miyakawa I. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen. Gynecol Obstet Invest 1999 48(3) 200-2. 

Fig. 9.15. Torsion of a paraovarian cyst. In a 14-year-old girl with severe acute pelvic pain a cystic lesion was found on sonography. CT shows normal ovaries in the ovarian fossa and a 7-cm cystic lesion (asterisk) in the cul-de-sac. The latter shows mild wall thickening at its left contour. Exploratory laparotomy found torsion of a right paraovarian cyst with involvement of the right fallopian tube. The ovaries were unremarkable...

The finding of a cystic ovarian tiunor, especially a dermoid cyst in young women who present with acute pain and vomiting is highly suspicious of adnexal torsion. 

Incompetent and dilated ovarian veins are frequently seen on CT in asymptomatic parous women (Fig. 17.11) [31]. Congenital or acquired vascular malformations of the uterus or parametria present also as vascular lesions. Contrast-enhanced CT or MRI may aid in the differentiation by the early enhancement of arteriovenous malformations in contrast to a more delayed enhancement in varicosities [32]. Adnexal masses with torsion or rare uterine tumors, especially choriocarcinomas may also be surrounded by thick, tortuous, well-enhanced vessels. The clinical background and imaging findings of an adnexal or uterine mass aid in the differential diagnosis. 

Fig. 7.16. Congenital ovarian cyst in a newborn of diabetic mother complicated by torsion. Longitudinal sonogram of the right hemiabdomen shows a large cyst with low-level echoes, a fluid-debris (blood) level, and an undulating thick membrane (flbrin arrowheads). The cyst decreased in size and resolved completely...

Godfrey H, Abernethy L, Boothroyd A (1998) Torsion of an ovarian cyst mimicking enteric duplication cyst on transabdominal ultrasound two cases. Pediatr Radiol 28 171-173... 

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