Severe left pelvic pain of 3 days duration
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The left ovary is enlarged (7.2x6.4x6.2 cm) as well as the ipsilateral fallopian tube (thickness=1.8 cm) of intermediate to low signal intensity on T1WI, low signal intensity on T2WI (probably due to an interstitial hemorrhage) with the high signal of the follicles which are displaced peripherally. Small corpus luteal cyst, as well as a hemorrhagic follicle, are noted within the ovary. The twisted pedicle is well-visualized on T2 sequences just cranial to the ovary. The postcontrast sequences demonstrate a peripheral enhancement with surrounding fat stranding and free fluid.
The right ovary is normal in appearance.
The uterus is of normal size and configuration with moderate diffuse thickening of the endometrial-myometrial junctional zone (~15 mm) of homogeneous low signal intensity on T2WI (adenomyosis)
MRI features are most consistent with left sided tubo-ovarian torsion which was confirmed at surgery.
Additional contributor: C. Boukaaba, MD