Presentation
Acute lower abdominal pain and nausea for 2 hours.
Patient Data
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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.
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.