Left ovarian torsion
Acute left lower abdominal pain for the last 4 days. Ultrasound done outside had raised the suspicion for left ovarian lesion.
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MRI images of pelvis show bulky left ovary measuring 4.4 x 5.6 x 3.5 cm (volume of 43 cc) with T2 hyperintense edematous stroma and peripherally displaced small follicles. The stroma shows T1 hyperintense signals - representing stromal hemorrhage. There are focal areas of restricted diffusion within the edematous, hemorrhagic ovarian stroma.
Twisted left vascular pedicle is noted leading upto the bulky left ovary.
No ovarian mass lesion noted.
These features are suggestive of left ovarian torsion.
Uterus and right ovary appear normal.
Mild free fluid is noted in Pouch of Douglas.
Acute lower abdominal pain in young adolescent females should prompt the exclusion of ovarian or adnexal torsion. Ultrasound is first line modality for diagnosing the ovarian torsion and to assess the viability of ovary.
MRI can be helpful in suspicious cases and in patients with underlying ovarian mass lesions.