Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to CT or MRI (the latter in pregnant … 1 Ovarian torsion … Gravid uterus, with a singleton mobile early gestation, not specifically assessed. In those with ovarian torsion, the most frequent sonographic signs were ovarian edema, abnormal ovarian blood flow, relative enlargement of the affected ovary, and the presence of free fluid around the ovary or in the Douglas pouch (Table 2). A high index of suspicion should be maintained, particularly if there is tenderness or mild swelling of an ovary containing a corpus luteum in early pregnancy. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian torsion is a medical emergency. Fig. Although diagnostic ultrasound is a frequently used imaging tool in patients with suspected OT, the mere presence of blood flow on Doppler ultrasonography of the adnexa has a poor … The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. 51 Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. Evangelia Vlachodimitropoulou Koumoutsea, Manish Gupta, Antony Hollingworth, Anwen Gorry, Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery, Case Reports in Obstetrics and Gynecology, 10.1155/2016/8426270, 2016, (1-3), (2016). It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. It commonly occurs between the 6th and 14th weeks of pregnancy 1. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. 51 Ovarian torsion occurs most commonly in the 1 st and 2nd trimesters, attributable to increased ligamentous laxity, rapid uterine growth, and a greater number of functional cysts present in early pregnancy. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. It usually occurs due to enlarged corpus luteum cyst. A corpus luteum is identified within this, as was seen on the preceding ultrasound (not shown). Ultrasound is the initial imaging modality of choice. However, rendering an accurate diagnosis of ovarian torsion is challenging. Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. A difference in diameter of the ovarian veins, with thinning of the twisted side and compensatory dilatation of the contralateral side for drainage of increased uterine blood flow, may be a useful imaging sign for the diagnosis of ovarian torsion during pregnancy. Sonogr… ADVERTISEMENT: Supporters see fewer/no ads. The … 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" Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. Ultrasound is the initial imaging modality of choice. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. ical evaluation for diagnosing ovarian torsion Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation Shauna Duigenan1 Esther Oliva2 Susanna I. Lee1 Duigenan S, Oliva E, Lee SI 1Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Ellison 234, 55 Fruit St, Boston, MA 02114. {"url":"/signup-modal-props.json?lang=us\u0026email="}. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Pelvic pain for three days. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. Ovarian torsion refers to complete or partial twisting of the vascular pedicle in the suspensory ligament, leading to obstructed lymphatic flow followed by obstructed venous flow and finally obstructed arterial flow. No cysts or lesions. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. Ovarian hyperstimulation syndrome is a relatively rare condition. In this study, the classic whirlpool sign was depicted in 2 incidences only in all cases (14.28%), and abnormal coils and loops were found in another two (14.28%). The incidence of ectopic pregnancy has increased from 0.37% of pregnancies in 1948 to approximately 2% of pregnancies in 1992 (,1). ADVERTISEMENT: Supporters see fewer/no ads. 1 week history of severe left iliac fossa pain. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. It can also be seen in pregnancy, but seldom in a normal single pregnancy. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. Known early pregnancy. Douglas Rogers, Ragheed Al-Dulaimi, Maryam Rezvani, Anne Kennedy, Akram Shaaban, Peripheral hypervascularity of the corpus luteum with ovarian edema (CLOE) may decrease false positive diagnoses of ovarian torsion, Abdominal Radiology, 10.1007/s00261-019-02091-3, (2019). The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. Background: To determine if asymmetric ovarian edema on non-contrast MRI can be used to distinguish torsed from non-torsed stimulated ovaries in pregnant women. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. [Abstract/Free Full Text] The delayed presentation (with initial US normal) highlights the difficulty sometimes encountered in making the diagnosis, particularly in the setting of pregnancy, and with intermittent detorsion. 12 ]. Normal right ovary, located posterolaterally relative to the uterus. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. The US appearance of the ovary raised high suspicion of left ovarian torsion. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. Overall, the incidence of ovarian torsion during pregnancy is about 1 in 5000 pregnancies. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. (2017) Clinical practice and cases in emergency medicine. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. Fertil Steril. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). gravid uterus with single intact gestational sac with a viable embryo with normal active pulsations of about 8 weeks of gestation, markedly enlarged (85 cc) with twisted pedicle and stromal edema with cystic changes and peripheral hypoechoic zone, all ovarian parenchyma are devoid of vascularity, suggestive of ovarian edema with impending cortical necrosis, Doppler study revealed twisted left ovarian pedicle with no detected vasculature along the ovarian parenchyma, consistent with left, mild free fluid is noted at the pelvis and right iliac fossa, normal size (3 cc) and sonographic features. 1. The vascular pedicle is also engorged, and there is a small amount of free fluid in the Pouch of Douglas.