Ovarian torsion rarely presents with classic symptoms. D ISCUSSION. 6 The incidence of ovarian masses during pregnancy is approximately 1 in 100 to 2000 pregnancies. Secondary Chang HC, Bhatt S, Dogra VS. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. This diagnosis encompasses either complete or partial rotation of the adnexa, which results in changes in the blood supply of the ovary, causing ischemia [].Risk factors include ovarian cysts, ovarian tumors, and fertility treatment []. Pena JE, Ufberg D, Cooney N, et al. Most patients present with severe non-specific lower abdominal and Lee SL, Ku YM, Choi BG, Kim JH, Kim YS. 2008 Sep-Oct. 28(5):1355-68. . An enlarged ovary with or without an underlying mass and a twisted pedicle, findings of torsion on ultrasound, are also seen on CT or MRI. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Although ultrasonography is typically the initial emergent examination, computed tomography (CT) and magnetic resonance (MR) imaging may also be useful diagnostic tools. The primary risk factor for ovarian torsion is an ovarian mass. Radiographics: a review publication of the Radiological Society of North America, Inc. 2008;28(5):1355–68. Ovarian torsion: a fifteen-year review. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Fertil Steril. In this article, we describe a case of a pregnant woman who presented with acute abdominal pain, vomiting, guarding, and rigidity. Radiographics. 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 the fifth common gynecological emergency. While US is a great first initial test for the evaluation of both ovarian torsion, do not be reassured by normal dopplers. Features that are better seen with CT or MRI include subacute ovarian hematoma and abnormal or absent ovarian enhancement. 2008;28(5):1355-68. link. Patient(s): A 23-year-old multiparous female with severe bilateral pelvic pain and a positive pregnancy test. J Ultrasound Med 2001; 20(10):1083–1089 13. The syndromeis relatively common, occurring in ~5% of patients undergoing in vitro fertilisation (IVF). View Article PubMed/NCBI Google Scholar 18. Torsion can happen with masses of any size and has been reported in cases with masses of 1 to 30 cm. [3] Chang HC, Bhatt S, Dogra VS (2008) Pearls and Pitfalls in Diagnosis of Ovarian Torsion. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Uterine and Ovarian Abnormalities. Sonography demonstrated an abnormal pelvic mass in all patients. There is probably an even higher incidence of the syndrome in "egg donors" due to their young age (which is a known risk factor for the disease) however there is a known problem of lack of reporting of such cases. Torsion is more common in an ovary that is greater than 5.0 cm in diameter (86 to 95% per multiple case studies.) Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian torsion rarely presents with classic symptoms. Her diagnosis was ovarian torsion, a complication of a previously identified ovarian dermoid cyst, resulting in an emergency cesarean section. 2000;73(5):1047-1050. “Ovarian Torsion.” Rosen's Emergency Medicine: Concepts and Clinical Practice, by Ron M. Walls et al., Elsevier, 2018. If not treated quickly, it can result in loss of an ovary. Discussion. [1,4] It is commonly seen in young women between 20 and 30 years of age with right ovary being more commonly affected, as sigmoid colon leaves limited space on the left. A coexistent mass within the ovary may or may not be present. Ann Emerg Med 2001; 38(2): 156-159. Common imaging findings of ovarian torsion in the prepubescent and adolescent populations include asymmetric enlargement of the ovary, peripheral location of ovarian follicles, and midline location of the ovary. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. Albayram F, Hamper UM. A coexistent mass within the ovary may or may not be present. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Ovarian torsion is defined as partial or complete rotation of the ovar-ian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Introduction. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Diagnosis. The most common finding is an ovary > 4cm. Objective: To describe a case of ruptured ectopic pregnancy and contralateral adnexal torsion after spontaneous conception. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Ovarian Torsion. Bider D, Mashiach … Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. The risk goes down when the size of the ovary becomes more massive (> 20.0 cm) due to decreased motility. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in ischemia. Ovarian torsion is a medical emergency. RadioGraphics 2008; 28: 1355-1368. Adnexal torsion is an emergency with confounding clinical and imaging features, resulting in low ovarian salvage rates, but by appreciating several key associations and observations, radiologists can improve early recognition and patient outcomes. While US is a great first initial test for the evaluation of both ovarian torsion, do not be reassured by normal dopplers. As It’s unclear how often ovarian torsion occurs, but doctors agree that it’s an uncommon diagnosis. RadioGraphics. References. More than 80% of patients with ovarian torsion had an ovarian mass of 5 cm or greater. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. 1. venous/lymphatic engorgement, edema, and hemorrhage. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly impor … Bookmarks (0) Pediatrics. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. The classic presentation of ovarian torsion is … Radiographics. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. Common imaging findings of ovarian torsion in the prepubescent and adolescent populations include asymmetric enlargement of the ovary, peripheral location of ovarian follicles, and midline location of the ovary. Ultrasonography (US) is the primary imaging modality for The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, [1,2,3] Torsion of the hyperstimulated ovary is much rarer. While it can rarely occur with a normal ovary, the majority of cases are associated with some type of ovarian pathology (e.g., tumor, cyst, hyperstimulation syndrome secondary to infertility treatments). The appearance was nonspecific, ranging from solid to cystic, but frequently reflected the commonly associated ovarian pathology present in 69% of patients. Pelvic free fluid. Design: Case report. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. The image below shows an approximately 3 cm hemorrhagic cyst within an ovary. Ovarian torsion affects women of all ages and is considered one of the more common gynecologic emergencies. Radiographics. 11. 2008 Sep-Oct. 28(5):1355-68. . 2008 Sep-Oct. 28(5):1355-68. . 12. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. pmid:18794312. Abstract. “Ovarian Torsion.” Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle resulting in obstruction to venous outflow and arterial inflow (1). Pelvic adnexal torsion is a collective term referring to twisting of an ovary, fallopian tube, or paraovarian cyst on its axis with … | Open in Read by QxMD Hasson J, Tsafrir Z, Azem F, et al. 2008; 28(5):1355-1368. Houry DL, Abbott JT. It is an infrequent but significant cause of … Ovarian torsion is usually accompanied by an underlying ovarian mass such as physiological cysts, endometriomas, benign neoplasms (eg, cystadenoma, teratoma, or fibroma), and malignancies (primary or metastatic). Radiographics. The sonographic and clinical findings of 13 patients with surgically proven ovarian torsion are reported. Setting: Tertiary university medical center. Pearls and pitfalls in diagnosis of ovarian torsion. Urgent message: Abdominal pain is an extremely common complaint in the urgent care setting.The differential diagnosis of abdominal pain is often a challenge, however, because many symptoms and signs are nonspecific. [] Predisposing factors are ovarian enlargement, adnexal masses, ovulation … Magnetic resonance (MR) imaging, have become more frequently used in the diagnosis of ovarian torsion, particularly in subacute cases.To assess the characteristic findings and diagnostic performance of preoperative MR imaging for ovarian torsion.Twenty-three patients (age range, 10 - 58 years; mean age, 28.4 ± 12.5 years) with suspected ovarian torsion underwent preoperative MR … Although ultrasonography is typically the initial emergent examination, computed tomography (CT) and magnetic resonance (MR) imaging may also be useful diagnostic tools. Ovarian torsion is usually associated with a cyst or tumour, which is typically benign; the most common being the mature cystic teratoma [7]. 2008; 28 (5):1355-68 (ISSN: 1527-1323) 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 usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage … multiple dilated, tortuous parauterine veins with a width >4 mm or an ovarian vein diameter greater than 5-6 mm Adnexal torsion commonly accompanies an ipsilateral ovarian neoplasm or cyst but can also occur in normal ovaries, usually in children. doi: 10.1148/rg.285075130 . Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. Clinical case: Ovarian torsion. Radiographics. A twisted pedicle, although not often detected on … The greatest risk factor for ovarian torsion is ovarian enlargement, typically caused by an ovarian cyst or mass. Pearls and pitfalls in diagnosis of ovarian torsion. Always consider torsion when evaluating a female patient with abdominal pain, back pain, or flank pain. The imaging features correspond to the degree of torsion and edema. Larger lesions are often surgically removed, as they are more prone to complications [5]. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Genitourinary. Bider D, Mashiach … Always consider torsion when evaluating a female patient with abdominal pain, back pain, or flank pain. RadioGraphics 28, 1355-1368 (PMID: 18794312 ) [4] Lee JH, Park SB, Shin SH, Jang JC, Lee WC, Jeong AK, Yang MJ (2009) Value of Intra-Adnexal and Extra-Adnexal Computed Tomographic Imaging Features Diagnosing Torsion and Adnexal Tumor. Adnexal torsion commonly accompanies an ipsilateral ovarian neoplasm or cyst but can also occur in normal ovaries, usually in children. RadioGraphics. Ovarian torsion is a gynecological emergency and is caused by the twisting of the ovary and fallopian tube on the vascular pedicle. 2008; 28 (5): p.1355-1368. It is one of the most common gynecologic emergencies. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Bider D, Mashiach … Huchon C, Fauconnier A. Adnexal torsion: a literature review. Comparison of adnexal torsion between pregnant and nonpregnant women. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. Ultrasonography (US) Magnetic resonance imaging (MRI) 1. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. an infrequent but significant cause of acute lower abdominal pain in women. 3.
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