Presentation
A female patient with a history of in vitro fertilization (IVF) presenting with increasing pain in the lower abdomen.
Patient Data
The uterus is gravid with two gestational sacs (GA 5 weeks, 2 days) following ovarian induction and IVF. Both ovaries are enlarged (right ovary volume 164 mL, left ovary volume 320 mL) with multiple cysts, and associated mild amount of free fluid in the hepatorenal pouch and pelvic region.
The left ovary is situated in midline position superior to the uterus, showing increased parenchymal echogenicity as compared to the right side without evidence of blood flow on color-flow imaging (despite using low flow scale which proved preserved blood flow in the right ovary).
Case Discussion
The patient was sent to the operating theater upon reporting of the findings. The torsed ovary was confirmed intra-operatively and histopathologically. The patient was followed up and her beta-HCG was increasing and doubling.
Ovarian torsion is a common complication of enlarged ovary. The sonographic findings of ovarian torsion include enlarged ovary, midline displacement of the ovary, echogenic parenchyma, twisted pedicle with or without flow on color-Doppler imaging.
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