Ovarian torsion

Case contributed by Khalid Alhusseiny
Diagnosis certain

Presentation

Recent onset of right sciatica. MRI of the lumbar spine was requested.

Patient Data

Age: 35 years
Gender: Female
mri

On the sagittal T2WI of the lumbar spine, the right ovary was seen enlarged, edematous, and close to the midline suggesting torsion.

Dedicated MRI of the pelvis was done which confirmed twisted right ovarian pedicle with whirlpool sign and lack of significant postcontrast ovarian enhancement denoting torsion, for which the patient underwent right oophorectomy.

There is also mild diffuse posterior bulge of L4-5 disc with small tear (HIZ).

Case Discussion

Ovarian torsion can affect all ages. It may be due to a complete or partial twist of the ovarian pedicle with the main risk factor is an underlying mass yet it can occur on normal ovary particularly in premenarchal girls who have elongated infundibulopelvic ligaments.

The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of treatment. Hence; early diagnosis of ovarian torsion is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity.

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