Ovarian torsion with paraovarian cyst

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Acute lower abdominal pain and nausea for 2 hours.

Patient Data

Age: 14 years
Gender: Female

Pelvis

mri
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Axial
T2
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Coronal
T2
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Sagittal
T2
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Axial T2
fat sat
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Coronal T2
fat sat
This study is a stack
Sagittal
T2 fat sat
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Coronal
T1
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Axial T1
fat sat
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Axial T1
C+ fat sat
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Info

The right ovary is enlarged (4.5 x 2.3 x 3.3 cm) showing multiple follicles and prominent stroma. It shows no appreciable enhancement in post-contrast sequences. A thickened twisted pedicle is noted.

Large cystic lesion is seen midline in the pelvis adjacent to right ovary measuring about 7.2 x 6.3 x 6 cm. It elicits fluid signal with thin wall.

Mild free fluid is seen deep in Douglas pouch.

Normal left ovary.

Case Discussion

Enlarged non-enhancing right ovary with thickened tortuous pedicle and prominent stroma associated with large paraovarian cyst and free pelvic fluid are all features consisting with ovarian torsion.

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