ADVERTISEMENT: Supporters see fewer/no ads. 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. When present, it is often associated with severe pain. Sonogr… Pelvic pain for three days. Initial ultrasound was normal. Ovarian hyperstimulation syndrome is a relatively rare condition. 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. 2009 Dec. 92(6):1983-7. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. 1. It is estimated that about 2.7% of surgical emergencies in women are comprised by ovarian torsion. 1 Ovarian torsion … Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. 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" Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. 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). 1 (2): 108-110. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. 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 … Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. (2017) Clinical practice and cases in emergency medicine. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. 12 ]. Magnetic resonance imaging demonstrated ovarian enlargement and edema. Ovarian Torsion. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. If not treated quickly, it can result in loss of an ovary. 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). After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. Ultrasound is the initial imaging modality of choice. Check for errors and try again. 12 weeks pregnant. Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. Normal right ovary, located posterolaterally relative to the uterus. 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. Ovarian torsion is a medical emergency. It is relatively uncommon at an incidence of approximately 1/1000 pregnancies, but may affect upwards of 16% of pregnancies achieved through ovarian hyperstimulation. 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. It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … AJR Am J Roentgenol 1988;150(3):647–649. However, heightened awareness and suspicion of this condition are needed for timely intervention. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. Up to 80% of these cases occur in patients who are at the reproductive age. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. `` url '': '' /signup-modal-props.json? lang=us\u0026email= '' } MRI and ultrasound appearance of torsion. 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