Severe left iliac fossa pain.
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The left ovary is enlarged measuring 4.8 x 2.3 x 4.2 cm (25 cc) with 10+ follicles. There is an adjacent cystic structure measuring 9.3 x 9.8 cm, which is multiloculated and may be a large para-ovarian cyst or be hydrosalpinx. No Doppler signal could be obtained within the left ovary. The patient is focally tender over the left ovary on both TA and TV scanning. Moderate volume of pelvic free fluid.
Anteverted uterus has a normal appearance with no focal myometrial lesion. Endometrium measures up to 10 mm. Right ovary is not identified.
There was clinical and sonographic features of ovarian torsion. The patient proceeded to laparoscopy which confirmed the diagnosis with the large cystic structure seen on ultrasound being two large ovarian cysts, which were presumably the lead point.