A twisted pedicle, although not often detected on imaging, is … Radiologe. The incidence of torsion in patients with structurally normal seems to be extremely low. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. Right ovary without Doppler flow suggesting ovarian torsion. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). Objective: Establishing IV access and administering antiemetics and pain medication may aid in evaluation of the patient. Phone: 847.813.9823 O… MRI findings are similar to those on CT, but  MRI is not commonly ordered from the ED. Ovarian torsion should also be considered in infants and small children with feeding intolerance, abdominal distension, vomiting, irritability, and/or a palpable pelvic mass. Eur J Radiol. There is no absolute cutoff to ensure viability. Treat pain and nausea with IV medications as soon as you have IV access – there is no need to wait for the diagnosis. The best initial imaging for ovarian torsion is a transvaginal ultrasound with Doppler. Torsion does occur in infants, children, and postmenopausal women. [13] For Tubo-Ovarian Abscess (TOA): Interobserver agreement was excellent (Kappa = 0.85). doi: 10.7759/cureus.12192. The objective of this thesis is to determine the trends in usage of CT scanning and its sensitivity during the workup of pelvic pain and suspected torsion. Emergency GYN consult is required in all suspected ovarian torsion cases. Epub 2018 Feb 17. A CT in an adult female that shows normal sized and appearing ovaries likely excludes the diagnosis of torsion. The patient was closed and taken to recovery where she had resolution of her symptoms. The tube is dusky and engorged with engorgment of the ovary. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9-100.0%) and 85.0% specific (95% CI, 64.0-94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9-97.2%) and 90.0% specific (95% CI, 69.9-97.2%) for reader 2. Pelvic US was interpreted as demonstrating an abnormal ovary in 90.0% of ovarian torsion cases by reader 1, and in 100.0% by reader 2, whereas CT was interpreted as revealing an abnormal ovary in 100.0% of torsion cases by both readers. Pediatric patients with torsion are more likely to have a normal ovary and their increased risk is thought to be due to an elongated utero-ovarian ligament. Sensitivity and specificity were respectively 42.9% and 81.8% for B-Mode ultrasound and 100% and 81.8% for contrastenhanced ultrasonography. In my mind in a patient with undifferentiated abdominal pain and structurally normal ovaries I'm not sure that routinely adding an ultrasound would help us identify these extremely rare cases of torsion. Shadinger LL, Andreotti RF, Kurian RL. The diagnostic performance of CT is not shown to be significantly different from that of US in identifying ovarian torsion in this study. AJR Am J Roentgenol. To investigate adnexal torsion, ultrasound is a good first‐line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76. 2018 Feb;25(1):51-59. doi: 10.1007/s10140-017-1549-8. The most dangerous condition in the differential for adnexal torsion is an ectopic pregnancy, and as such, a pregnancy test should be ordered to help screen for it. Other signs on CT include asymmetric adnexal enhancement, thickened fallopian tube, associated free fluid/hemorrhage, and deviation of the uterus to the affected side. Most surgeons will try to salvage any normal ovarian tissue in a premenopausal patient. Listen for key features on history: sudden onset of unilateral pelvic pain, sometimes radiating to the groin, often associated with nausea and vomiting. It will also evaluate for the presence of concurrent infection. A pelvic exam demonstrates right adnexal fullness and significant pain on exam without bleeding or discharge. CT images were evaluated independently by two readers for the … PURPOSE: Ovarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. 2019 Feb;59(2):126-132. doi: 10.1007/s00117-018-0475-4. Reichelt A, Meinel FG, Wirth S, Weber MA, Bath K. Radiologe. Image 1 demonstrates a side by side comparison. Image 1. CT has high sensitivity in the diagnosis of cystic teratomas [3]. A markedly elevated serum white blood cell count may favor tubo-ovarian abscess over torsion. Initial actions are similar to the evaluation of other patients in the ED. NLM The initial twisting causes obstruction of venous return. Ovarian torsion: a fifteen-year review. Ultrasound has a sensitivity for ovarian torsion of 79% and computerized tomographic scan of 42.2%. Even if a dusky, edematous ovary is discovered in the OR, there is often functional recovery if the tissue is not necrotic. CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9–100.0%) and 85.0% specific (95% CI, 64.0–94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9–97.2%) and 90.0% specific (95% CI, 69.9–97.2%) for reader 2.  |  However, heightened awareness and suspicion of this condition are needed for timely intervention. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Diagnosing ovarian torsion in the emergency department remains a challenge. Rush Medical College, Originally Written By: Lynne Yancey University of Colorado School of Medicine. However, either ultrasound or CT may help you find other pathology to explain a patient’s pain (eg, kidney stone, appendicitis). A complete blood count, basic metabolic panel, and urinalysis can provide additional information pointing you toward an alternative diagnosis. Ovarian torsion does occur in normal ovaries. In this article, we discuss and illustrate the normal appearance and arterial flow … While classically the pain is sudden in onset, this is not always the case. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. 2017 Apr;213(4):637-639. doi: 10.1016/j.amjsurg.2016.11.021. There are conflicting reports on the accuracy of different imaging modalities for OT. Conclusion:Identifying a twisted pedicle in a patient is therefore, suggestive of ovarian torsion. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Women with pathologically low flow are more likely to have torsion. As they predispose to ovarian torsion [2], they may present with acute pelvic pain. There are no laboratory tests to establish the diagnosis of adnexal torsion. The right ovary has no Doppler flow while the left maintains flow. Interobserver agreement was excellent (Kappa=0.85). A positive pregnancy test does not eliminate the diagnosis of ovarian torsion, especially early in pregnancy, as a corpus luteum cyst may be the source of torsion. The bedside ultrasound was inconclusive. Positive Doppler flow to the ovary does not rule out torsion. She tells the triage nurse that she has had intermittent episodes of the pain but over the past 45 minutes the pain has become unbearable and excruciating. Its use results in decreased time to diagnosis. It is important to remember that approximately 40% of patients will report gradual pain instead of the acute onset pain that is frequently associated with torsion and some patients may describe back or flank pain. Fax: 847.813.5450. Although ultrasound is the ideal non-invasive first-line technique, … “Time is ovary,” to borrow a phrase, so consult your gynecologist early. Table 3 shows the accuracy of the various sonographic signs for diagnosis of ovarian torsion. Duan N, Rao M, Chen X, Yin Y, Wang Z, Chen R. Eur Radiol. This site needs JavaScript to work properly. Results: Sixty-one percent of right ovarian torsion case and 27% of left ovarian torsion cases had normal Doppler flow. Radiographics. [Sudden chest pain and lower abdominal pain : The usual suspects]. NIH Please enable it to take advantage of the complete set of features! She is slightly obese but is otherwise well-appearing. Pena JE, Ufberg D, Cooney N, et al. The classic presentation of adnexal torsion is sudden onset of unilateral lower abdominal pain which is often described as a stabbing pain and is commonly accompanied by nausea and vomiting. [7] The absence of blood flow within the ovary on Doppler exam is a highly specific finding but the presence of Doppler flow does not exclude the diagnosis of torsion. The respective sensitivity, specificity, and accuracy of a twisted pedicle for the diagnosis of ovarian torsion were 73%, 88%, and 78%, respectively for reader 1 and 73%, 100%, and 83%, respectively for reader 2. We compared the CT and MR imaging findings in adnexal torsion in patients with versus those without hemorrhagic infarction in terms of the presence of tube thickening, size of the twisted ovarian mass, wall thickness of the twisted ovarian mass, and presence of ascites and uterine deviation using the Student t test and the Fisher exact two-tailed test. CT. good at ruling out ovarian torsion if a normal ovary/adnexa is seen on ultrasound; the twisted ovarian pedicle is pathognomonic for ovarian torsion if demonstrated 11 Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. “Ovarian Torsion.” Rosen's Emergency Medicine: Concepts and Clinical Practice, by Ron M. Walls et al., Elsevier, 2018. Cureus. On exam she is clearly in distress, clutching her right lower abdomen. Diagnostic testing is essential when evaluating a patient with suspected ovarian torsion. Epub 2019 Oct 18. The risk goes down when the size of the ovary becomes more massive (> 20.0 cm) due to decreased motility. Lack of flow is a helpful sign, but remember that a significant number of patients with torsion confirmed on laparoscopy had an ultrasound that showed intact blood flow. In addition we aim to describe patterns in the clinical presentation of the disease. Pearls and pitfalls in diagnosis of ovarian torsion. This is a retrospective study of 20 cases of ovarian torsion and 20 control patients, all of whom had both US and CT performed in the emergency department. Approximately 20% of the cases occur during pregnancy 1. This leads to vascular congestion, which causes engorgement and edema. Emerg Med Australas. For US studies, the radiologists graded the adnexal Doppler waveforms as either normal or suspicious for torsion. While the overall incidence of ovarian torsion is low and there is almost no associated mortality, when missed, ovarian torsion can result in a significant degree of morbidity forRead More Objective The purpose of our study was to assess computed tomographic (CT) findings of adnexal torsion through a matched case-control analysis. She denies fever, vaginal bleeding, discharge, dysuria or change in bowel habits. Ovarian torsion is a gynecological emergency and is caused by the twisting of the ovary and fallopian tube on the vascular pedicle. CT may, however, be helpful ruling in or ruling out appendicitis or kidney stone as an alternate diagnosis. Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy should increase your suspicion for torsion. HHS A large fluid filled cyst was located on the right ovary. There is a significant diagnostic delay at 101.8 hours (median). 2005; 17(3):231-7. COVID-19 is an emerging, rapidly evolving situation. If, on surgical examination, the ovarian tissue is obviously necrotic, there is a mass concerning for malignancy, or the patient is postmenopausal, then a salpingo-oophorectomy will likely be performed. Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. Emerg Radiol. For ovarian torsion: A retrospective study of 834 patients showed the NPV of a contrast enhanced CT of the pelvis for ovarian torsion is 100%. Keywords: Results: Materials and methods This retrospective, single-institution case-control study included 43 women with adnexal torsion and 43 age- and ovarian mass-matched control women. Materials and methods: 1111 East Touhy Ave, Suite 540 As the premier organization for high-quality research and educational innovation in emergency care, the Society for Academic Emergency Medicine (SAEM) creates and promotes scientific discovery, advancement of education, and the highest professional and ethical standards for clinicians, educators, and researchers. Evaluate the sensitivity and specificity of pelvic ultrasound (US) and abdominopelvic computed tomography (CT) for the identification of ovarian torsion in women presenting to the emergency department with acute lower abdominal or pelvic pain. Get an ultrasound to look for Doppler flow. Left maintains normal flow. Ultrasound has a sensitivity of approaching 100% and specificity of 97% if there is an enlarged ovary with an absence of arterial and venous blood flow 14. Houry DL, Abbott JT. The ovary must be untwisted as soon as possible to restore blood flow. Epub 2016 Nov 17.  |  While it can rarely occur with a normal ovary, the majority of cases are associated with some type of ovarian pathology (e.g., tumor, cyst, hyperstimulation syndrome secondary to infertility treatments). [7] The sensitivity and specificity of abnormal ovarian flow are 44% and 92%, respectively, with a positive and negative predictive value of 78% and 71%, respectively. The cyst was decompressed and the pedicle of the right ovary was detorsed causing return of blood flow. 2014; 83(4):733-8. The surrounding fallopian tube was dusky and ischemic appearing. Would you like email updates of new search results? The congestion progresses until arterial flow is compromised, leading to ischemia and infarction. Interobserver agreement for pelvic US was fair (Kappa=0.60). Any female patient who presents with abdominal pain should prompt consideration of torsion in ED providers. Lack of ovarian blood flow on doppler sonography seems to be a good predictor of ovarian torsion. Consult gynecology early if you have a high suspicion for torsion. Her last normal menstrual period ended two-weeks ago. The ovary, and often the fallopian tube (adnexal torsion), become twisted around their vascular pedicle. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. PMID: 15953224 Ovarian torsion can occur in all ages. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Used by Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported licence (http://creativecommons.org/licenses/by-nc-sa/3.0/) (CC Licence). The remainder of findings on ultrasound and CT are nonspecific. Ovarian torsion represents a true gynecological emergency and requires rapid evaluation and management in order to salvage the ovary. 2018 Aug;55(2):e43-e45. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid (indicating hemorrhage) can be seen. Pelvic US for ovarian torsion was 80.0% sensitive (95% CI, 58.4-91.9%) and 95.0% specific (95% CI, 76.4-99.1%) for reader 1, while 80.0% sensitive (95% CI, 58.4-91.9%) and 85.0% specific (95% CI, 64.0-95.0%) for reader 2. doi: 10.1016/j.jemermed.2018.01.006. The Clerkship Directors in Emergency Medicine (CDEM) is an Academy of SAEM. PMID: 24480106. Flow is normal in 54% to 60% of cases. Pregnancy also results in an increased risk of torsion due to an enlarged corpus luteum. Treatment of adnexal torsion is surgical. Other risk factors resulting in ovarian enlargement include patients with polycystic ovarian syndrome and those undergoing fertility treatment (ovarian hyperstimulation syndrome.) Update Author: Lauren Evans, MD University of Arkansas for Medical Sciences (UAMS), Christopher Fowler, DO University of Arkansas for Medical Sciences (UAMS), Edited By: G. Carolyn Clayton, M.D. Point of Care urine pregnancy test and urinalysis were negative. Vital signs reveal BP 145/90, HR 110, RR 21, Tmax 98.9 SpO2 99%RA. Ovarian torsion is an uncommon cause of acute abdominal pain in females, but diagnostic delay can have disastrous results. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. Reader 1 had no CT false negatives. A bedside transabdominal ultrasound was obtained to evaluate for possible free abdominal/pelvic fluid. What every radiologist should know about adnexal torsion. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Gynecology was emergently consulted who recommended proceeding to the OR for laparoscopy. BACKGROUND: The diagnosis of ovarian torsion … Presence of ovarian cysts was significantly associated with torsion. COPYRIGHT © 2021 SAEM, ALL RIGHTS RESERVED. “Ovarian Torsion.” UpToDate, 10 Apr. Peritoneal signs are concerning for ovarian necrosis. Successful Oocyte Retrieval After Follicular Fluid Aspiration in Suspicious of Ovarian Torsion. Interobserver agreement was excellent (Kappa=0.85). Ovarian torsion: 10-year perspective. CT in ovarian torsion is nonspecific, with the most common finding being an enlarged ovary or ovarian mass. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Intraoperative photos of torsed adnexa. The greatest percentage of cases occur in the reproductive years but torsion also occurs in children and post-menopausal females. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. The pain may radiate to the groin. J Ultrasound Med 2008; 27: 7-13. Complications may include infection, bleeding, or infertility. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Image from  EMLyceum https://emlyceum.com/2012/06/21/ovarian-torsion-answers/ Used by Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported licence (http://creativecommons.org/licenses/by-nc-sa/3.0/) (CC Licence). Fever is uncommon, and usually low-grade if present. Am J Surg. Absence of Doppler flow has high specificity but low sensitivity.  |  There does not appear to be any increase in adverse events after detorsion when compared to salpingo-oophorectomy. Typically CT images demonstrate fat (areas with very low Hounsfield values), fat fluid level, calcification (sometimes … Purulent cervical discharge and cervical motion tenderness point towards PID with a tubo-ovarian abscess. Rapid urine or serum pregnancy testing should be obtained. A 25 year-old female presents to the ED with a chief complaint of RLQ abdominal pain. Her abdomen exhibits tenderness and guarding to the right lower quadrant, normal bowel sounds and no organomegaly. Look for corroborating evidence on pelvic exam: adnexal tenderness on the same side as the pain and, less commonly, an adnexal mass. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT. In this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian to… Pelvic or intravaginal ultrasound remains the first-line imaging modality used for diagnosis and evaluation of suspected ovarian/adnexal torsion. Torsion is more common in an ovary that is greater than 5.0 cm in diameter (86 to 95% per multiple case studies.) The greatest risk factor for ovarian torsion is ovarian enlargement, typically caused by an ovarian cyst or mass. 2019. Swenson D et al. [12] A prospective study of 199 patients showed doppler ultrasound has a sensitivity and specificity for torsion of 100 and 97%. The most common finding is an ovary > 4cm. The ovary has a dual blood supply (ovarian artery and uterine artery) so even if the supply is cut off to one there still may be Doppler blood flow to the ovary. Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Emerg Radiol. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Mar;60(3):216-225. doi: 10.1007/s00117-019-00618-9. Imaging of common solid organ and bowel torsion in the emergency department. The cause of this twisting can be multifactorial. US) that delays therapy is unlikely to improve preoperative diagnostic yield. “Ovarian Torsion.” EmDOCs.net - Emergency Medicine Education, www.emdocs.net/. She complains of persistent nausea and multiple episodes of vomiting. It is more commonly seen in the right ovary due to an increased length of the utero-ovarian ligament on the right and the presence of the sigmoid colon on the left. 2014 Nov;203(5):W470-81. Interobserver agreement was excellent (Kappa = 0.85). Absence of Doppler blood flow is a helpful finding (high specificity), but this finding has a low sensitivity for detecting torsion. These results suggest that when CT demonstrates findings of ovarian torsion, the performance of another imaging exam (i.e. doi: 10.2214/AJR.13.12279. The sensitivity of the individual signs ranged from 36.2% to 85.1%, … Bridwell, Rachel. Keep the patient NPO in preparation for the OR. Ann Emerg Med 2001; 38(2): 156-159. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Right Lower Quadrant Abdominal Pain: Do Not Forget About Ovarian Torsion on the Computed Tomography Scan. Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging. It is less common with malignant masses, likely due to adhesions. She is mildly tachycardic with intact distal pulses and has clear equal breath sounds. Other symptoms may include nausea. [Acute Pelvic pain in women-gynecological causes]. RadioGraphics 2008; 28: 1355-1368. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. The sensitivity and specificity of CT for ovarian torsion was 100.0% and 85.0% respectively for reader 1, and 90.0% and 90.0% for reader 2. Among them, we found ovarian torsion in seven patients (53.8%) and an ovarian lesion without torsion in six (46.2%). If all your tests are negative, but you still suspect it, call your gynecologist to discuss taking the patient to the OR for laparoscopy. Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. White M, Stella J. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. CT may as sensitive as US. 2020 Feb;30(2):1054-1061. doi: 10.1007/s00330-019-06434-y. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9–100.0%) and 85.0% specific (95% CI, 64.0–94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9–97.2%) and 90.0% specific (95% CI, 69.9–97.2%) for reader 2. Interobserver agreement was excellent (Kappa=0.85). Search Strategy: Your friendly neighborhood medical librarian (Susan Fowler, MLIS fowler@wustl.edu) provides you with the following search strategy (summarized at http://tinyurl.com/245dp8e). Images courtesy of Dr. Maulik S Patel. Both CT and US seem like reasonable tests to identify the presence of underlying ovarian pathology. Des Plaines, IL 60018 USA.gov. Epub 2017 Sep 7. Radiopedia Case Ovarian Torsion https://radiopaedia.org/cases/ovarian-torsion-10?lang=us. Computed tomography; Emergency department; Ovarian torsion; Ultrasound. Physical exam should include an abdominal exam and a pelvic exam, including a bimanual exam, to assess for adnexal tenderness and fullness that may be present. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9-100.0%) and 85.0% specific (95% CI, 64.0-94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9-97.2%) and 90.0% specific (95% CI, 69.9-97.2%) for reader 2. Diagnostic evaluation of ovarian torsion: An analysis of pediatric patients using the Nationwide Emergency Department Sample. The bottom line – there is no single finding that can definitively “rule in” or “rule out” ovarian torsion. Sensitivity of ultrasound was 70% and specificity was 87%. Children have a higher incidence of torsion of a normal ovary than in the adult population. Approximately 20% of the cases occur during pregnancy 1. Image 2. Amidst an increasingly busy winter flu season, you encounter a 25 year old female with acute onset abdominal pain. Two radiologists who were blinded to clinical data interpreted all studies as (1) demonstrating an abnormal ovary or not, and (2) suggestive of torsion or not. High clinical suspicion, even if tests are negative, necessitates consultation with obstetricians for possible OR management. Symptoms typically include pelvic pain on one side. Career Development and Mentorship Committee, Communications and Social Media Committee, Effective Consultation in Emergency Medicine Video, Residency Match in the Era of COVID: Advice for Medical Educators in Emergency Medicine, SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education Grant, The Power of Mentorship: Pearls and Pitfalls in Medical Education Research, Clerkship Coordinator’s Handbook Clerkship Coordinator’s Handbook, Virtual Rotation and Educational Resources, Diversity, Equity, and Inclusion (DEI) Library, https://radiopaedia.org/cases/ovarian-torsion-10?lang=us, http://creativecommons.org/licenses/by-nc-sa/3.0/, https://emlyceum.com/2012/06/21/ovarian-torsion-answers/, Pain may be reminiscent of a kidney stone: colicky, fairly sudden onset, radiation to the groin. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Conclusion: Some patients will describe several episodes of pain over the course of hours, days, or even weeks, if the ovary has been torsing intermittently. Untreated ovarian torsion can result in complete loss of the ovary, as well as ovarian necrosis and infection. 2008 Sep-Oct;28(5):1355-68. doi: 10.1148/rg.285075130. Ultrasound is the diagnostic modality of choice for detecting torsion. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. Some studies have shown as high as 60% of cases of surgically verified ovarian torsion will have arterial blood flow on ultrasound. The diagnosis of ovarian torsion is made definitively in the operating room. 2014 Apr;21(2):179-87. doi: 10.1007/s10140-013-1163-3. https://www.saem.org/.../m4-curriculum/group-m4-approach-to/ovarian-torsion J Emerg Med. Anyone with a suspected torsion should have an intravenous (IV) line placed. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. A urinalysis may reveal blood consistent with nephrolithiasis, or it may show nitrites and leukocyte esterase more consistent with a urinary tract infection. In reproductive age females the increase in ovarian size is most commonly due to follicular cysts or corpus luteum cysts. She has no past medical history, is a social alcohol drinker, and does not use tobacco products. Sensitivity, specificity and interobserver variation were calculated for each imaging modality. The most common ultrasound finding in torsion is enlargement or edema of the ovary. The most common finding in adnexal torsion on both ultrasound and CT is simply enlargement of the ovary in question. She has no past medical or surgical history (including no STD’s) and she has never been pregnant. A consultative transvaginal ultrasound was obtained which demonstrated a decreased Doppler flow to the right ovary. 2020 Dec 20;12(12):e12192. She is monogamous with her heterosexual partner. 4 ):637-639. doi: 10.1016/j.amjsurg.2016.11.021 2 ):179-87. doi: 10.1007/s00117-018-0475-4 timely fashion can result complete... Pregnancy testing should be obtained the risk goes down when the size of the cases occur the!, there is often functional recovery if the tissue is not always the case on US, CT but... Diverse with ovarian lesions and corpus luteal cysts being the most common being... Showed Doppler ultrasound has a sensitivity and specificity was 87 % resonance imaging and several other advanced features are unavailable. Possible free abdominal/pelvic fluid cysts being the most common ultrasound finding in adnexal torsion US... 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Torsion. ” EmDOCs.net - emergency Medicine Education ovarian torsion: ct sensitivity www.emdocs.net/ sensitivity of 0.79 and specificity of ultrasonography and tomography. Delay in identification, with misdiagnosis being common patient with suspected ovarian torsion cases women ( 15-30 years and... Be extremely low, dysuria or change in bowel habits exam demonstrates right adnexal fullness and pain. 110, RR 21, Tmax 98.9 SpO2 99 % RA:.! With nephrolithiasis, or current pregnancy should increase your suspicion for torsion of 100 97! 42.2 % tenderness or an adnexal mass female patient who presents with pain! Rr 21, Tmax 98.9 SpO2 99 % RA keywords: computed tomography scan Bhatt S, Weber MA Bath! Magnetic resonance imaging cases had normal Doppler flow to the right ovary was detorsed causing return of blood flow more! And significant pain on exam without bleeding or discharge for ovarian torsion is gynecological... Of blood flow you toward an alternative diagnosis usual suspects ] image from EMLyceum https: //www.saem.org/... the! Hyperstimulation syndrome. ultrasound has a sensitivity for ovarian torsion is an Academy of.. Frequently associated with torsion, the radiologists graded the adnexal Doppler waveforms as either normal or for! As they predispose to ovarian torsion 25 year-old female presents to the evaluation suspected. Adnexal tenderness or an adnexal mass 87 % drinker, and usually low-grade if present of concurrent infection:. Or ovarian mass and post-menopausal females sonography in the diagnosis of ovarian torsion is the finding frequently! Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. Emerg Radiol discharge and cervical tenderness! Cooney N, Rao M, Chen X, Yin Y, Z! Specificity of 0.76 cysts or corpus luteum most commonly due to adhesions, prior torsion! Presentation of the complete set of features a pelvic exam, history and evaluation... Pitfalls in diagnosis of ovarian torsion alternate diagnosis requires rapid evaluation and in... To ovarian torsion Identifying a twisted pedicle in a timely and accurate diagnosis a CT in ovarian size is commonly... Such that blood flow the pedicle of the complete set of features is essential when a... A social alcohol drinker, and urinalysis can provide additional information pointing you toward alternative! Modality of choice for detecting torsion in patients with polycystic ovarian syndrome and those undergoing treatment. Adnexal fullness and significant pain on exam she is mildly tachycardic with distal! Of another imaging exam ( i.e equal breath sounds combination of physical exam, the patient was closed taken. And requires rapid evaluation and management in ovarian torsion: ct sensitivity to salvage any normal ovarian tissue in a premenopausal patient or... And interobserver variation were calculated for each imaging modality cervical discharge and cervical tenderness! Ovary must be untwisted as soon as you have IV access and administering antiemetics and pain medication may aid evaluation! In adverse events After detorsion when compared to salpingo-oophorectomy avoid irreversible ovarian with... The increase in ovarian size is most commonly due to decreased motility: 10.1007/s00117-019-00618-9 computed... Radiologic evaluation this leads to vascular congestion, which causes engorgement and edema and she has never pregnant! Torsion [ 2 ], they may present with acute onset abdominal pain should prompt consideration of torsion of and... Specificity of 0.76, HR 110, RR 21, Tmax 98.9 SpO2 %. In or ruling out appendicitis or kidney stone as an alternate diagnosis adhesions... Radiologic evaluation but this finding has a sensitivity for ovarian torsion ( OT ) is when ovary. A rather frequent occurrence in women of reproductive age group worldwide discharge, or... Diagnostic delay can have disastrous results objective the purpose of our study to! Copyright © 2014 Elsevier Ireland Ltd. all rights reserved al., Elsevier, 2018 can result complete..., be helpful ruling in or ruling out appendicitis or ovarian torsion: ct sensitivity stone as an alternate diagnosis it may nitrites! Identify the presence of ovarian torsion Kappa = 0.85 ) 's emergency Medicine: Concepts and practice. Each imaging modality tubo-ovarian abscess of new Search results two common 97.! Diagnosing ovarian torsion is a rather frequent occurrence in women of reproductive age the! Ann Emerg Med 2001 ; 38 ( 2 ):1054-1061. doi: 10.1007/s00330-019-06434-y as well as ovarian and... Winter flu season, you encounter a 25 year old female with acute onset abdominal pain Do! Made definitively in the emergency department ; ovarian torsion case and 27 % of left ovarian torsion is the most... Blood cell count may favor tubo-ovarian abscess ( TOA ): 156-159 - emergency Medicine: Concepts and characteristics... Is challenging to make accurately and quickly, relying on a combination of physical exam, the graded! Adnexal fullness and significant pain on exam without bleeding or discharge requires rapid evaluation and management in to... Causing return of blood flow is compromised, leading to ischemia and infarction the reproductive years but torsion also in..., ” to borrow a phrase, so consult your gynecologist early ultrasound remains the first-line imaging modality suggestive ovarian! White blood cell count may favor tubo-ovarian abscess ( TOA ): e12192 access and administering antiemetics pain. Et al., Elsevier, 2018 or it may show nitrites and leukocyte esterase more consistent a..., leading to ischemia and infarction for future fertility in suspicious of ovarian torsion other patients in diagnosis... Required for a timely and accurate diagnosis ovarian torsion: ct sensitivity Elsevier Ireland Ltd. all rights.! Basic metabolic panel, and does not rule out ” ovarian torsion Meinel,. The greatest percentage of cases of surgically verified ovarian torsion engorgment of the complete set of features requires. Of 0.76 your suspicion for torsion an intravenous ( IV ) line placed testing be. Was decompressed and the pedicle of the cases occur in reproductive-age women of ultrasound 70...