Magnetic resonance imaging demonstrated ovarian enlargement and edema. Evangelia Vlachodimitropoulou Koumoutsea, Manish Gupta, Antony Hollingworth, Anwen Gorry, Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery, Case Reports in Obstetrics and Gynecology, 10.1155/2016/8426270, 2016, (1-3), (2016). a, bColor flow on Doppler US images demonstrates the twisted pedicle (arrows) in a 12-year-old girl with a large, mature cystic teratoma (T) arising from the left adnexa, representing the lead point for left adnexal torsion - "Pediatric ovarian torsion: a pictorial review" Initial ultrasound was normal. Ovarian torsion is a medical emergency. Fertil Steril. Background: To determine if asymmetric ovarian edema on non-contrast MRI can be used to distinguish torsed from non-torsed stimulated ovaries in pregnant women. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. ADVERTISEMENT: Supporters see fewer/no ads. (2017) Clinical practice and cases in emergency medicine. {"url":"/signup-modal-props.json?lang=us\u0026email="}. The color Doppler showed persistent arterial vascularity in the left ovary. The presence of arterial flow within the ovary suggest either an incomplete torsion, or … The pelvic ultrasound showed significant enlargement of the left ovary exhibiting a large anechoic cyst with edema of the ovarian stroma and free intraperitoneal fluid effusion. Ectopic pregnancy occurs when a blastocyst abnormally implants outside the endometrium of the uterus. A twisted pedicle, although not often detected on imaging, is … Fig. Sonogr… MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Methods: In this retrospective study, our radiology database was searched for women who were pregnant and who had undergone ovarian stimulation and underwent MRI abdomen/pelvis from 1/2000-12/2012. After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. Douglas Rogers, Ragheed Al-Dulaimi, Maryam Rezvani, Anne Kennedy, Akram Shaaban, Peripheral hypervascularity of the corpus luteum with ovarian edema (CLOE) may decrease false positive diagnoses of ovarian torsion, Abdominal Radiology, 10.1007/s00261-019-02091-3, (2019). If not treated quickly, it can result in loss of an ovary. The vascular pedicle is also engorged, and there is a small amount of free fluid in the Pouch of Douglas. gravid uterus with single intact gestational sac with a viable embryo with normal active pulsations of about 8 weeks of gestation, markedly enlarged (85 cc) with twisted pedicle and stromal edema with cystic changes and peripheral hypoechoic zone, all ovarian parenchyma are devoid of vascularity, suggestive of ovarian edema with impending cortical necrosis, Doppler study revealed twisted left ovarian pedicle with no detected vasculature along the ovarian parenchyma, consistent with left, mild free fluid is noted at the pelvis and right iliac fossa, normal size (3 cc) and sonographic features. Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. Radiology 1985;154(3):773–775. It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. Check for errors and try again. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. The delayed presentation (with initial US normal) highlights the difficulty sometimes encountered in making the diagnosis, particularly in the setting of pregnancy, and with intermittent detorsion. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. Gravid uterus, with a singleton mobile early gestation, not specifically assessed. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. In those with ovarian torsion, the most frequent sonographic signs were ovarian edema, abnormal ovarian blood flow, relative enlargement of the affected ovary, and the presence of free fluid around the ovary or in the Douglas pouch (Table 2). Unable to process the form. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. A high index of suspicion should be maintained, particularly if there is tenderness or mild swelling of an ovary containing a corpus luteum in early pregnancy. Introduction. Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy. The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. The … 12 ]. In this article, we discuss and illustrate the normal appearance and arterial flow … The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to CT or MRI (the latter in pregnant … Interestingly, arterial flow with normal waveforms was detected in both the ovary and its pedicle, suggesting either an incomplete torsion, or an element of torsion-detorsion. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. Sonogr… Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. In this study, the classic whirlpool sign was depicted in 2 incidences only in all cases (14.28%), and abnormal coils and loops were found in another two (14.28%). The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. Most cases are caused by dermoid and functional ovarian cysts. 1 (2): 108-110. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. Uterine adnexal torsion: sonographic findings. Ovarian Torsion. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 6,8. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. Up to 80% of these cases occur in patients who are at the reproductive age. It is relatively uncommon at an incidence of approximately 1/1000 pregnancies, but may affect upwards of 16% of pregnancies achieved through ovarian hyperstimulation. Ovarian torsion refers to complete or partial twisting of the vascular pedicle in the suspensory ligament, leading to obstructed lymphatic flow followed by obstructed venous flow and finally obstructed arterial flow. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. 2009 Dec. 92(6):1983-7. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Without surgical intervention, the ovary may be lost; therefore, the diagnosis is important. No cysts or lesions. 8 Ultrasound whirlpool sign in ovarian torsion. Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? Ultrasound is the initial imaging modality of choice. Known early pregnancy. Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. 1 Ovarian torsion … It is located in the pouch of Douglas and is enlarged to approximately 50cc. The US appearance of the ovary raised high suspicion of left ovarian torsion. An ultrasound was performed for correlation with the initial ultrasound from 1 week ago, which was normal (not shown). 1. Check for errors and try again. Although diagnostic ultrasound is a frequently used imaging tool in patients with suspected OT, the mere presence of blood flow on Doppler ultrasonography of the adnexa has a poor … Ultrasound is the initial imaging modality of choice. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Etiology and pathophysiology. 12 weeks pregnant. When present, it is often associated with severe pain. 1 week history of severe left iliac fossa pain. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. [Abstract/Free Full Text] Ovarian hyperstimulation syndrome is a relatively rare condition. ADVERTISEMENT: Supporters see fewer/no ads. Although mortality decreased by nearly 90% from 1979 to 1992, ectopic pregnancy remains the leading cause of death during the first trimester of pregnancy, with a 9%–14% mortality rate (,1,,2). AJR Am J Roentgenol 1988;150(3):647–649. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. It usually occurs due to enlarged corpus luteum cyst. It can also be seen in pregnancy, but seldom in a normal single pregnancy. O&G - Clinical Conditions - Ovarian - Gynae. Normal right ovary, located posterolaterally relative to the uterus. Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. However, rendering an accurate diagnosis of ovarian torsion is challenging. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 51 Ovarian torsion occurs most commonly in the 1 st and 2nd trimesters, attributable to increased ligamentous laxity, rapid uterine growth, and a greater number of functional cysts present in early pregnancy. Unable to process the form. However, heightened awareness and suspicion of this condition are needed for timely intervention. It commonly occurs between the 6th and 14th weeks of pregnancy 1. Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. It is important to consider torsion when ovarian masses are discovered in pregnant patients with severe abdominal or pelvic pain . MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. Overall, the incidence of ovarian torsion during pregnancy is about 1 in 5000 pregnancies. Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. ical evaluation for diagnosing ovarian torsion Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation Shauna Duigenan1 Esther Oliva2 Susanna I. Lee1 Duigenan S, Oliva E, Lee SI 1Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Ellison 234, 55 Fruit St, Boston, MA 02114. It is estimated that about 2.7% of surgical emergencies in women are comprised by ovarian torsion. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). The torsion of a pedunculated subserous leiomyoma is a rare complication of uterine leiomyoma in pregnancy but should be considered in a pregnant woman with acute onset abdominal pain. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. A difference in diameter of the ovarian veins, with thinning of the twisted side and compensatory dilatation of the contralateral side for drainage of increased uterine blood flow, may be a useful imaging sign for the diagnosis of ovarian torsion during pregnancy. Although this sign is specific for ovarian torsion, yet it had been variably reported as seen in 13–88% of patients with ovarian torsion , , . A corpus luteum is identified within this, as was seen on the preceding ultrasound (not shown). It usually occurs due to enlarged corpus luteum cyst. Pelvic pain for three days. 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