Ovarian torsion


Ovarian torsion manifests as complex enlarged adnexal mass with peripherally arranged follicles secondary to displacement by edematous ovarian stroma.

Enlarged ovaries from cysts or masses (>5 cm) remain the predisposing factor, the commonest cause being cystic teratoma.

The massively enlarged ovary is often too big to be contained within the pelvis and thus migrates superiorly and toward the midline and can be shifted to the contralateral side, usually lying in front of the uterus. This adnexal movement pulls the uterus out of its usual position and toward the side of the affected ovary. The altered position and relationship of the ovary and uterus are highly suggestive of adnexal torsion. 

In our case the right ovary is enlarged and shifted to the opposite side containing multiple peripherally located follicles and large superior cyst which could be the leading cause, with normally located left ovary. Radiological features are consistent with right ovarian torsion.