Ovarian torsion

Case contributed by Qutaiba Jaf'ar Mahmoud
Diagnosis almost certain

Presentation

Left lower abdominal pain three days ago.

Patient Data

Age: 5 years
Gender: Female
mri
This study is a stack
Axial
T2
This study is a stack
Axial T1
fat sat
This study is a stack
Coronal
T2
This study is a stack
Sagittal
T2
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Axial
Gradient Echo
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
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Info

The left ovary appears enlarged with heterogeneous stroma and multiple peripherally placed follicles, it is showing diffusion restriction, and diffuse blooming artifact associated with free fluid, surrounding fat stranding, and twisted left pedicle.
After contrast administration, the left ovarian parenchyma is not enhanced, apart from a thin rim of peripheral enhancement.

The uterus appears compressed by the enlarged left ovary.

 The right ovary appears unremarkable.

 

Case Discussion

Features are highly suggestive of left ovarian torsion with evidence of hemorrhagic infarction, regarding the MRI findings.

DWI can help in the early diagnosis and treatment of ovarian ischemia to prevent potential complications1.

Lower ADC levels caused by hemorrhagic infarction compared with non-hemorrhagic infarction1.

In addition, the presence of blooming artifacts in gradient images gives supportive evidence for hemorrhage.

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