The features are in keeping with right ovarian torsion with consequent hemorrhagic and edematous changes. The diagnosis is suspected first based on the clinical setting of pelvic pain and tenderness.
Doppler ultrasound is the first imaging modality should be done as an emergency condition that usually shows tender examination, enlarged edematous ovary and free pelvic fluid. A twisted pedicle is a specific sign, however absence of internal vascular signals is a late finding and not necessarily be elicited in the presentation.
Pelvic MRI is commonly used to evaluate lower abdominal pain and suspected pelvic masses.