History 10 years old female patient presented to ER with severe
pelviabdominal pain, the pain was severe ¬ relieved by
analgesics, she complained of severe vomiting as well.
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Ultrasound
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CAT scan of the abdomen &pelvis
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DDx DDX for other causes of acute abdomen such as:
Appendicitis,acute Ovarian cysts Diverticular diseases PID
Endometriosis Pregnancy,Ectopic Mesenteric ischemia Pregnancy,UTI
Obstruction,large bowel UTI,female DDx for enlarged ovary with
multiple peripheral cysts(follicles) by US: 1.Ovarian torsion.
2.polycystic ovary disease 3. Ovarian hyper stimulation syndrome
(OHSS) 4. Hemorrhagic ovarian cysts 5-PID 6-Neoplasms rare(primary
or secondary most commonly (lymphoma).
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Diagnosis Ovarian Torsion
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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. Torsion of a normal ovary is most common
among young children, in whom developmental abnormalities such as
excessively long fallopian tubes may be responsible.
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US features of ovarian torsoion: *Unilateral enlarged ovary
(>4 cm)( The most constant finding in ovarian torsion ) The
volume of the twisted ovary averages 2 8 times the normal size !!!.
The ovarian stroma may be heterogeneous (2ry to hemorrhage and
edema ) String of pearls sign(Peripherally arranged follicles)
Coexistent mass within the twisted ovary Free pelvic fluid Twisted
vascular pedicle *Usually located in the midline. American Journal
of Roentgenology
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mymedicineworld.net Color Doppler Imaging The color Doppler low
manifestations of ovarian torsion are highly variable and are
based, in part, on the degree of vascular compromise. The classic
color Doppler sonographic finding in ovarian torsion is the absence
of arterial low. The presence of flow 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
f low in the twisted vascular pedicle may indicate that the ovary
is not viable. Whirlpool Sign
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CT findings in ovarian torsion: 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 adenxal cystic mass, fallopian tube
thickening, peripheral cystic structures, and ascites.
Understanding the imaging appearance of ovarian torsion will lead
to conservative, ovary- sparing treatment.
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radswiki.net British Journal of Radiology
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MRI : radswiki
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DDx DDx for enlarged ovary with multiple peripheral
cysts(follicles) by US: 1.Ovarian torsion. 2.polycystic ovary
disease occurs starting from menarche till menopause the patient is
usually obese & complaining of hirstusim,amenorrhea&
infertility,enlarged both ovaries with prominent follicles
3.Ovarian hyper stimulation syndrome (OHSS) is a rare, potentially
fatal, iatrogenic complication of ovulation stimulation for the
treatment of infertility. 4.Hemorrhagic ovarian cysts are called
the great imitator owing to their multiple appearances depending on
the age of the hemorrhagic cysts are isoechoic its hard to DDx it
from enlarged ovary only the follow up which demonstrates
resolution of the cyst. 5-PID 6-Neoplasms rare(primary or secondary
most commonly ( lymphoma ).