Ovarian torsion

Case contributed by Dr Mostafa El-Feky

Presentation

Abdominal pain.

Patient Data

Age: 40 years
Gender: Female

Pelvis

MRI

The right ovary is markedly enlarged measuring 6 x 8.5 x 10 cm in maximum dimensions.  It shows heterogeneous T2 predominantly hyperintense signal with two peripherally located cysts averaging 3-3.5 cm, one of them showing T2 hypointense signal the other one shows a fluid level. Heterogeneous T1 mixed hyper and hypointense signals. Minimal post-contrast enhancing internal strands. 

Twisting of the right ovarian pedicle (best seen in axial T1 C+ fat sat sequence) with the uterus deviated to the right side. A rim of peri-ovarian T1 hyperintense fluid. 

The left ovary is unremarkable.

Case Discussion

The features are in keeping with right ovarian torsion with consequent hemorrhagic and edematous changes. The diagnosis is suspected first based on the clinical setting of pelvic pain and tenderness.

Doppler ultrasound is the first imaging modality should be done as an emergency condition that usually shows tender examination, enlarged edematous ovary and free pelvic fluid. A twisted pedicle is a specific sign, however absence of internal vascular signals is a late finding and not necessarily be elicited in the presentation.

Pelvic MRI is commonly used to evaluate lower abdominal pain and suspected pelvic masses.

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