Ovarian torsion

Case contributed by Raad Al Tahat
Diagnosis almost certain


Lower abdominal pain

Patient Data

Age: 20 years
Gender: Female

The right ovary is markedly enlarged, high in position and displaced toward the left side, containing multiple peripherally located small follicles and large superior cyst. Twisted and engorged vessels are seen adjacent to the right ovary.

Small amount of pelvic free fluid.

The left ovary appears normal in size and location.

Case Discussion

Ovarian torsion manifests as complex enlarged adnexal mass with peripherally arranged follicles secondary to displacement by edematous ovarian stroma.

Enlarged ovaries from cysts or masses (>5 cm) remain the predisposing factor, the commonest cause being cystic teratoma.

The massively enlarged ovary is often too big to be contained within the pelvis and thus migrates superiorly and toward the midline and can be shifted to the contralateral side, usually lying in front of the uterus. This adnexal movement pulls the uterus out of its usual position and toward the side of the affected ovary. The altered position and relationship of the ovary and uterus are highly suggestive of adnexal torsion. 

In our case the right ovary is enlarged and shifted to the opposite side containing multiple peripherally located follicles and large superior cyst which could be the leading cause, with normally located left ovary. Radiological features are consistent with right ovarian torsion.

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