Presentation
24 hours history of severe pelvic pain mainly on the left.
Patient Data
Enlarged left ovary of low signal on T1, high signal on T2 with no enhancement seen on postcontrast sequences (dynamic and delayed sequences). Numerous small follicles mainly of peripheral distribution. Evidence of twisted thickened vascular pedicle well-demonstrated on all sequences.
A large well-defined left paratubal unilocular cystic lesion (15 x 13 x 8 cm ) of homogeneous low T1 and high T2 content with no enhancement on postcontrast sequences. Free intraperitoneal fluid around the cystic lesion and in Douglas pouch.
Focal thickening of the endometrial-myometrial junctional zone (thickness = 20 mm) of right corporeal location, probably focal adenomyosis.
Normal appearance of the right ovary containing numerous small follicles.
Case Discussion
The MRI features are most consistent with an ovarian torsion due to a paratubal cyst that was confirmed at surgery.