Ovarian torsion

Case contributed by Aws Qahtan Hamdi


The female patient presented with sudden onset of severe left lower abdominal pain and nausea.

Patient Data

Age: 30 years
Gender: Female

Pelvic ultrasound shows an enlarged left ovary (> 4 I'm) with hyperechoic stroma and peripherally displaced follicles (follicular ring sign).

There is an absence of internal vascularity in color Doppler study.

There is an associated scanty pelvic free fluid and pelvic tenderness during the examination.

Case Discussion

Ovarian torsion refers to the rotation of the ovary and portion of the fallopian tube supplying the vascular pedicle. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. It is caused by either hypermobility of the ovary or adnexal masses. 

Ultrasound is the initial modality of choice used to diagnose ovarian torsion. The differential diagnosis includes pelvic inflammatory disease (PID), and massive ovarian edema (MOO).

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