Torsion of dermoid cyst in a primigravid

Case contributed by Dr Ammar Haouimi

Presentation

Acute right lower abdominal pain in a primigravid at 18 weeks gestation. The ultrasound showed a complex heterogeneous mass in the right lower quadrant.

Patient Data

Age: 25 years
Gender: Female

Well-circumscribed complex mass in the right lower flank and iliac fossa with mainly two components

  • a fatty component of high signal intensity on both T1 and T2 attenuated on T1 fat sa
  • a complex solid floating component (Rokitansky nodule) with attenuation of the central fatty component on T1 fat sat, containing a hemorrhagic area of high signal intensity

Note engorged vessels with mild effusion around the mass. The left ovary is well-visualized on T2 sequences.

Case Discussion

MRI features of torsion of an ovarian dermoid cyst in a primigravid patient that was confirmed at surgery (triple torsion).

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