Ovarian torsion

Case contributed by Dr Mostafa El-Feky

Presentation

Severe abdominal pain with irregular menses.

Patient Data

Age: 20 years
Gender: Female
MRI

Pelvis

Markedly enlarged edematous left ovary reaching up to 515 cc (11.5 x 10.5 x 8.5 cm). It exhibits marked stromal edema and congestion (manifested as subtle T1 hyperintensities) still with preserved residual mainly sub-1.5 cm. There are peripherally located follicles in addition to a 1.5 corpus luteum. Diffuse reticular pattern of the intra-ovarian vascular tree reflecting blood stagnation.

Whorly appearance of the related free edge broad ligament containing prominent ectatic fallopian tube, still no frank hydrosalpinx, and neurovascular bundle which shows marked vascular congestion and tortuosity; confirming twisted pedicle.

It’s seen prolapsing into the Douglas pouch into midline and right paramedian position pushing the uterus into an exaggerated AVF axis and effacing the right ovary inferolaterally.

Associated parametrial reflections congestion and surrounding mild to moderate pelvic/Douglas pouch collection.

No associated left adnexal cystic, solid or suspicious lesions identified on imaging basis in order to be considered acting as a leading point.

The right ovary reveals average follicular reserve for age. No associated adnexal cystic, solid or suspicious lesions.

Case Discussion

Features are consistent with left ovarian torsion with marked ovarian enlargement and edema, twisted thickened vascular pedicle (Whirlpool sign) and free pelvic fluid. 

No associated adnexal solid or cystic lesions identified on imaging basis in order to be considered acting as a leading point. A long vascular pedicle could be a predisposing factor.

It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis.  

 

Case courtesy Prof. Dr. Heba Hassan Professor of woman imaging, Alexandria university, Egypt.

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Case information

rID: 68399
Published: 6th Jul 2019
Last edited: 14th Aug 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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