Ovarian torsion - pediatric

Case contributed by Mostafa El-Feky

Presentation

Pelvic pain for one day

Patient Data

Age: 7 years
Gender: Female
ultrasound

Right ovary is enlarged in size (5.5 x 3.3 cm) with homogeneous hyperechoic texture and peripherally distributed follicles. It is located in the midline posterior to the urinary bladder. Twisted right ovarian pedicle with high resistive waveform of the right ovarian artery before the twist, in keeping with compromised arterial flow. No venous flow detected at the right ovarian pedicle, consistent with venous occlusion. 

No detected flow at the right ovarian parenchyma on color Doppler on very low Doppler settings. No current signs of parenchymal infarctions at the time of examination. Mild free pelvic collection. No right ovarian cysts or lesions.

Left ovary is average in size (2.2 x 1 cm), located at left adnexa with no lesions identified. Normal low resistive arterial waveform of parenchymal vascularity.

Postoperative follow up

ultrasound

Postoperative follow-up after three weeks revealed normal size of both ovaries (RT=2.5 cc and LT=2.2 cc), with adnexal location and normal sonographic features.

Case Discussion

Ultrasound features of ovarian torsion present are:

  • enlarged ovary > 4 cm
  • change in ovarian echogenicity (hyperechoic)
  • midline position
  • peripherally displaced follicles 
  • twisted pedicle with high resistive arterial Doppler before the twist
  • absent ovarian parenchymal vascularity
  • free pelvic fluid

Laparoscopy was done on the same day and right ovarian detwisting and fixation was done.

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