Presentation
Pelvic pain for three days. Known early pregnancy.
Patient Data
The uterus:
- gravid uterus with single intact gestational sac with a viable embryo with normal active pulsations of about 8 weeks of gestation
- no focal or diffuse myometrial lesions
Left ovary:
- located at the pelvis above the uterus
- markedly enlarged (85 cc) with twisted pedicle and stromal edema with cystic changes and peripheral hypoechoic zone, all ovarian parenchyma are devoid of vascularity, suggestive of ovarian edema with impending cortical necrosis
- Doppler study revealed twisted left ovarian pedicle with no detected vasculature along the ovarian parenchyma, consistent with left ovarian torsion
- it shows large paraovarian cyst at its pedicle with thin wall and clear fluid content measuring 4 x 5.2 cm
- mild free fluid is noted at the pelvis and right iliac fossa
Right ovary:
- normal size (3 cc) and sonographic features. No cysts or lesions
- located at the right adnexal region
Case Discussion
Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. It commonly occurs between the 6th and 14th weeks of pregnancy 1. It usually occurs due to enlarged corpus luteum cyst.
In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage.