Ovarian torsion

Case contributed by Muthu Magesh
Diagnosis certain


Lower abdominal pain with severe tenderness.

Patient Data

Age: 5 years
Gender: Female

Large well-defined solid cystic lesion with peripheral enhancing solid component and septations is seen in the midline likely arising from left adnexa, abutting the urinary bladder inferiorly and displacing the rectosigmoid junction posteriorly. The mass is abutting the small bowel loops superiorly and left external iliac vessels. Both ovaries are not separately visualized. There is suspicion of a whirl sign medially and posteriorly to the mass.
No evidence of calcification/Fat attenuation lesion within.
Uterus appears significantly compressed and displaced by the lesion
Impression: Features are highly suggestive of ovarian torsion.

Case Discussion

Surgically proven case of left ovarian torsion.

Ovarian torsion is one of the major causes of acute abdomen in children. It is caused by elongated tube (increased mobility)or long/absent mesentery. The preceding factors for ovarian torsions are ovarian cysts, teratoma and other mass in adnexa. Most commonly right ovary is involved. Quick and confident diagnosis is important in saving the adnexal structures from vascular compromise.

Prognosis is excellent with appropriate treatment.

Imaging features

USG: Primary evaluation. Enlarged ovary with reduced or absent blood flow can indicate torsion.

CT:  For definitive diagnosis. Solid mass or target appearance around adnexa can indicate rotated fallopian tube and hyperdensities within can indicate hemorrhage. Uterus deviation, adnexal fat stranding and free fluid in abdomen can be indirect sign.

Differential diagnosis: Ovarian neoplasm and tubo-ovarian mass.

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