Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). 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. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … 51 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. 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. In this article, we discuss and illustrate the normal appearance and arterial flow … 2009 Dec. 92(6):1983-7. O&G - Clinical Conditions - Ovarian - Gynae. 1. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. {"url":"/signup-modal-props.json?lang=us\u0026email="}. [Abstract/Free Full Text] Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. Unable to process the form. Fertil Steril. It is relatively uncommon at an incidence of approximately 1/1000 pregnancies, but may affect upwards of 16% of pregnancies achieved through ovarian hyperstimulation. Most cases are caused by dermoid and functional ovarian cysts. The pelvic ultrasound showed significant enlargement of the left ovary exhibiting a large anechoic cyst with edema of the ovarian stroma and free intraperitoneal fluid effusion. It commonly occurs between the 6th and 14th weeks of pregnancy 1. Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. An ultrasound was performed for correlation with the initial ultrasound from 1 week ago, which was normal (not shown). A twisted pedicle, although not often detected on imaging, is … It usually occurs due to enlarged corpus luteum cyst. Ovarian torsion is a medical emergency. Ultrasound is the initial imaging modality of choice. Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . Etiology and pathophysiology. It is located in the pouch of Douglas and is enlarged to approximately 50cc. Sonogr… 8 Ultrasound whirlpool sign in ovarian torsion. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. 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. Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Overall, the incidence of ovarian torsion during pregnancy is about 1 in 5000 pregnancies. The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. The … 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). Pelvic pain for three days. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. 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. 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. Check for errors and try again. The color Doppler showed persistent arterial vascularity in the left ovary. Although this sign is specific for ovarian torsion, yet it had been variably reported as seen in 13–88% of patients with ovarian torsion , , . Unable to process the form. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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 … It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. Sonogr… The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. The classic clinical presentation overlaps that of appendicitis and includes nausea, vomiting, and pelvic pain. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. Without surgical intervention, the ovary may be lost; therefore, the diagnosis is important. However, rendering an accurate diagnosis of ovarian torsion is challenging. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. A corpus luteum is identified within this, as was seen on the preceding ultrasound (not shown). ADVERTISEMENT: Supporters see fewer/no ads. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. Ultrasound is the initial imaging modality of choice. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Ovarian hyperstimulation syndrome is a relatively rare condition. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. 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 … The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. It is important to consider torsion when ovarian masses are discovered in pregnant patients with severe abdominal or pelvic pain . 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. Up to 80% of these cases occur in patients who are at the reproductive age. Ovarian Torsion. Interestingly, arterial flow with normal waveforms was detected in both the ovary and its pedicle, suggesting either an incomplete torsion, or an element of torsion-detorsion. 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. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. Introduction. Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. 12 weeks pregnant. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. ADVERTISEMENT: Supporters see fewer/no ads. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. 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. No cysts or lesions. 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" Known early pregnancy. 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%). Gravid uterus, with a singleton mobile early gestation, not specifically assessed. Radiology 1985;154(3):773–775. Fig. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. The torsion of a pedunculated subserous leiomyoma is a rare complication of uterine leiomyoma in pregnancy but should be considered in a pregnant woman with acute onset abdominal pain. After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. 1 week history of severe left iliac fossa pain. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. 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. The US appearance of the ovary raised high suspicion of left ovarian torsion. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. It usually occurs due to enlarged corpus luteum cyst. 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. Check for errors and try again. However, heightened awareness and suspicion of this condition are needed for timely intervention. 12 ]. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? The incidence of ectopic pregnancy has increased from 0.37% of pregnancies in 1948 to approximately 2% of pregnancies in 1992 (,1). Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. Methods: In this retrospective study, our radiology database was searched for women who were pregnant and who had undergone ovarian stimulation and underwent MRI abdomen/pelvis from 1/2000-12/2012. 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. Initial ultrasound was normal. The vascular pedicle is also engorged, and there is a small amount of free fluid in the Pouch of Douglas. 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. 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). AJR Am J Roentgenol 1988;150(3):647–649. (2017) Clinical practice and cases in emergency medicine. It can also be seen in pregnancy, but seldom in a normal single pregnancy. The presence of arterial flow within the ovary suggest either an incomplete torsion, or … When present, it is often associated with severe pain. Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Uterine adnexal torsion: sonographic findings. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Normal right ovary, located posterolaterally relative to the uterus. Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. If not treated quickly, it can result in loss of an ovary. 1 Ovarian torsion … Magnetic resonance imaging demonstrated ovarian enlargement and edema. 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 is estimated that about 2.7% of surgical emergencies in women are comprised by ovarian torsion. 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