Presentation
Severe pelvic pain.
Patient Data
Enlarged left ovary located in Douglas pouch (measuring 8 x 7 x 5.6 cm), eliciting a high signal peripherally on T1 extending to the ovarian pedicle (rim of methemoglobin), high signal on T2 with no enhancement is seen on postcontrast sequences. Small follicles mainly of peripheral distribution. Evidence of twisted thickened vascular pedicle.well-visualized on all sequences. A large well-defined cystic lesion arising from the left ovary (measuring 13 x 10 x 6 cm) of high signal on both T1 and T1 with a declive sediment of low signal on T2 suggestive of a hemorrhagic cyst. A small amount of free fluid is seen in the Douglas pouch.
Normal appearance of the left ovary containing numerous small follicles (largest measures 24 mm).
Normal anteverted retroflexed the uterus.
Case Discussion
The MRI features are suggestive of an ovarian torsion due to a hemorrhagic ovarian cyst.
In 50-80%, the ovarian torsion occurs in a patient with an adnexal mass and <50% in a patient with ovarian hypermobility.
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