Patient with pain in the iliac region for two days. Transabdominal ultrasound examination inconclusive.
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Left ovary shows increased volume and density from hemorrhagic infarction (~50 HU) with torsion of the pedicle and moderate amount of low density free peritoneal fluid.
Ovarian torsion (adnexal torsion) is an infrequent, but significant, cause of acute lower abdominal pain in women. This condition is usually associated with reduced venous outflow from the ovary, resulting in stromal edema or internal hemorrhage. It can be caused by hyperstimulation or a mass.
The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. A quick and confident diagnosis is required to save the ovary from infarction.