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Ovarian Torsion

Ovarian Torsion

Pedicle?

rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.

The ovarian pedicle is made up part of the fallopian tube, mesovarium, ovarian ligament, and ovarian blood vessels (artery and vein)

What causes ovarian torsion?

mesovarium - part of the broad ligament of the uterus that covers the ovary

hypermobility of the ovary: <50%

adnexal mass: ~50-80%

results in venous, arterial and lymphatic stasis --> hemorrhagic infarction/necrosis

Clinical presentation

  • Severe, non specific abd pain

-intermittent vs sustained

  • Nausea/vomiting
  • Tenderness with palpation (adnexal tenderness)

What do I order?

  • Leukocytosis

CT

Ultrasound

Not ovarian torsion

  • enlarged (>4 cm) ovary
  • variable echogenicity (hypo- or hyperechoic)
  • cystic or hemorrhagic degeneration

- long standing infarct

  • peripherally displaced follicles with hyperechoic central stroma
  • free pelvic fluid (>80% of cases)

US showed normal ovary/adnexa

Look for:

  • enlarged ovary
  • twisted ovarian pedicle (pathognomonic!) for ovarian torsion
  • pedicle may also appear distended
  • adnexal mass, midline, rotated to the contralateral side
  • deviation of the uterus to the affected ov side
  • HU >50 on non-contrast CT = hemorrhagic necrosis

Hemorrhagic ovarian cysts:

variable appearance depending on age of blood

They commonly result from bleeding into the CL or follic. cyst.

stages of bleeding

-Active anechoic at sonography

-Clot formation

-Retraction echogenic focus within an anechoic

structure

-Resolution

- Hounsfield Units (HU) make up the grayscale in medical CT imaging

Doppler

  • Edematous ovary
  • peripherally displaced follicles
  • large CL
  • twisted pedicle

Variable findings

  • Little to no venous flow
  • Absent arterial flow (less common)
  • Normal

-dual supply from both the ovarian and uterine arteries

Hemorrhagic ovarian cysts

Color Doppler image of an ovary shows an enlarged solid

mass with no evidence of normal ovarian tissue or

flow, an appearance suggestive of a hemorrhagic cyst.

These findings could be easily confused with those of

a twisted ovary.

Whirlpool sign :

twisted ovarian vascular pedicle

US image shows an ovarian cyst with avascular irregular regions of solid appearing tissue due to clot retraction.

US image shows an ovarian cyst

that contains multiple echogenic bands against a hypoechoic background. This fishnet appearance represents residual fibrin strands

https://pubs.rsna.org/doi/pdf/10.1148/rg.285075130

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