Ovarian torsion due to dermoid cyst

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Two days history of severe pelvic pain. The ultrasound exam (not shown) revealed a complex pelvic mass.

Patient Data

Age: 30 years
Gender: Female

Large left ovarian mass of retrovesical location. It elicits a complex signal intensity, the main components are of fatty signal attenuated on fat-suppressed sequences, containing small fatty nodules "floating balls sign". No enhancement seen on the postcontrast sequences.

Evidence of twisted thickened vascular pedicle of the left ovary well-visualized on all sequences.

A small amount of free fluid is seen in the Douglas pouch.

Normal appearance of the uterus and right ovary.

Case Discussion

The MRI features are suggestive of an ovarian torsion due to a dermoid cyst that was confirmed at surgery.

In 50-80%, the ovarian torsion occurs in a patient with an adnexal mass and <50% in a patient with ovarian hypermobility.

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