Presentation
One day of severe abdominal pain with vomitus, to rule out right ovarian torsion or appendicitis.
Patient Data
Globularly unilaterally enlarged right ovary (measuring 41.14 cc in volume) with heteroechogenic parenchymal distortion and countable peripherally sitting sub-centimeter follicles is noted. On color and power Doppler evaluation, there is no parenchymal flow signal within the right ovary. A large, septated and walled-off, predominantly fluid-filled and anechoic structure parades ipsilaterally within the right adnexa supero-medially and continues with the right oviduct (which appeared as an organized hematoma during imaging, but later got confirmed as a para-ovarian cystic lesion). Subtle clear fluids of centimetric depths is seen within the Douglas Pouch and within the Morrison's pouch.
The left ovary: Normal both in parenchymal echopattern and follicular pattern and demonstrating unremarkable spectral flows with its intra-ovarian systolic velocity at 16.1 cm/s and a resistive index of 0.49 plus a pulsatility index of 0.64, noted is normal.
Specimen: Gross pathology of the torsed right ovary.
POST OPERATIVE FINDING:
Large ovarian cyst fused to the fallopian tube, all twisted and necrosed. Right salpingoophorectomy performed.
Case Discussion
Trans-abdominal ultrasound features reflecting torsed right sided ovary confirmed post-operatively. No sonographic or surgical features of an inflamed appendix was seen. A twisted vascular pedicle was visualized conspicuously supero-laterally towards the right ovarian peripheral aspect on power Doppler mapping.