Presentation
Three days history of severe right lower quadrant pain.
Patient Data
Enlarged right ovary of intermediate signal on T1, heterogeneous low signal on T2, containing numerous small follicles displaced peripherally with twisted vascular pedicle giving the appearance of a whirlpool sign. A thin rim of peripheral enhancement is noted on postcontrast sequences (infarcted ovary).
A large well-defined cystic lesion arising from the right ovary (8.5 cm) of low signal on T1, high signal on T2 and sediment of declining signal posteriorly as well as a peripheral enhancement on postcontrast sequences, suggestive of a hemorrhagic cyst.
Normal appearance of the uterus and left ovary containing numerous small follicles.
A small amount of free fluid is seen in the Douglas pouch.
Case Discussion
The MRI features most consistent with an ovarian torsion due to a hemorrhagic ovarian cyst, that was confirmed at surgery.
In 50-80%, the ovarian torsion occurs in a patient with an adnexal mass and <50% in a patient with ovarian hypermobility.
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