It commonly occurs between the 6th and 14th weeks of pregnancy 1. It is located in the pouch of Douglas and is enlarged to approximately 50cc. Check for errors and try again. Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. It is important to consider torsion when ovarian masses are discovered in pregnant patients with severe abdominal or pelvic pain . 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. 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. Magnetic resonance imaging demonstrated ovarian enlargement and edema. AJR Am J Roentgenol 1988;150(3):647–649. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. Without surgical intervention, the ovary may be lost; therefore, the diagnosis is important. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Most cases are caused by dermoid and functional ovarian cysts. Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. 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" Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. [Abstract/Free Full Text] 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. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. It is estimated that about 2.7% of surgical emergencies in women are comprised by ovarian torsion. Fig. 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%). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Ectopic pregnancy occurs when a blastocyst abnormally implants outside the endometrium of the uterus. 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. Gravid uterus, with a singleton mobile early gestation, not specifically assessed. 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. Sonogr… {"url":"/signup-modal-props.json?lang=us\u0026email="}. Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. O&G - Clinical Conditions - Ovarian - Gynae. 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. 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. Fertil Steril. The color Doppler showed persistent arterial vascularity in the left ovary. It can also be seen in pregnancy, but seldom in a normal single pregnancy. Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. Sonogr… Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. 8 Ultrasound whirlpool sign in ovarian torsion. Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy. However, rendering an accurate diagnosis of ovarian torsion is challenging. Although this sign is specific for ovarian torsion, yet it had been variably reported as seen in 13–88% of patients with ovarian torsion , , . Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . A twisted pedicle, although not often detected on imaging, is … 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 … Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. Unable to process the form. 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 … Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. 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. In this article, we discuss and illustrate the normal appearance and arterial flow … The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. 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. Unable to process the form. It usually occurs due to enlarged corpus luteum cyst. 12 ]. 2009 Dec. 92(6):1983-7. Normal right ovary, located posterolaterally relative to the uterus. Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. 1 week history of severe left iliac fossa pain. 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). The classic clinical presentation overlaps that of appendicitis and includes nausea, vomiting, and pelvic pain. However, heightened awareness and suspicion of this condition are needed for timely intervention. Initial ultrasound was normal. 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. Known early pregnancy. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. 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. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. Pelvic pain for three days. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … 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. ADVERTISEMENT: Supporters see fewer/no ads. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. 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). It is relatively uncommon at an incidence of approximately 1/1000 pregnancies, but may affect upwards of 16% of pregnancies achieved through ovarian hyperstimulation. Ultrasound is the initial imaging modality of choice. Although mortality decreased by nearly 90% from 1979 to 1992, ectopic pregnancy remains the leading cause of death during the first trimester of pregnancy, with a 9%–14% mortality rate (,1,,2). Etiology and pathophysiology. Introduction. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. Up to 80% of these cases occur in patients who are at the reproductive age. 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. If not treated quickly, it can result in loss of an ovary. 51 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. The presence of arterial flow within the ovary suggest either an incomplete torsion, or … No cysts or lesions. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. {"url":"/signup-modal-props.json?lang=us\u0026email="}. When present, it is often associated with severe pain. 1. After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. Radiology 1985;154(3):773–775. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in 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. 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. Check for errors and try again. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 1 Ovarian torsion … The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. 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). 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. 1 (2): 108-110. Ovarian torsion is a medical emergency. Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. Ovarian Torsion. The … 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. (2017) Clinical practice and cases in emergency medicine. The US appearance of the ovary raised high suspicion of left ovarian torsion. 12 weeks pregnant. An ultrasound was performed for correlation with the initial ultrasound from 1 week ago, which was normal (not shown). Ultrasound is the initial imaging modality of choice. The incidence of ectopic pregnancy has increased from 0.37% of pregnancies in 1948 to approximately 2% of pregnancies in 1992 (,1). Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). Overall, the incidence of ovarian torsion during pregnancy is about 1 in 5000 pregnancies. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. A corpus luteum is identified within this, as was seen on the preceding ultrasound (not shown). ADVERTISEMENT: Supporters see fewer/no ads. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. 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