Ovarian torsion

Case contributed by Naqibullah Foladi


A 9-year-old girl presented with abdominal pain for 6 days, associated with nausea and vomiting, the pain started from the right and left quadrant, localized in RLQ, the pain is periodic. Bowel habit normal, U/S shows a well-defined heterogeneous lesion in right hemipelvis without vascularity.

Patient Data

Age: 9 years old
Gender: Female

Left ovary is enlarged in size with diffuse parenchymal edema showing intermediate signal in T2 weighted images and low signal in T1 weighted images. Multiple sub centimetric follicles are visualized in the periphery of the left ovary. The left ovarian pedicle is twisted. No contrast enhancement is seen in the left ovary after IV administration of gadolinium.  
The right ovary is slightly enlarged, containing multiple follicles showing normal parenchymal enhancement in post-contrast sequences.  
The uterus is small in size, compatible with the age.  
Diffuse contrast enhancement is seen in the parametrium, most likely reactional.  
No free fluid is seen in the cul de sac of Douglas.  
No supra centimetric enlarged lymph node is seen in the iliac lymphatic chain bilaterally.  
Visualized bony structures are returning normal signals.  

Case Discussion

The features are consistent with left ovarian torsion.  



This case is also contributed by Dr. Najibullah Rasouly

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