O&G - Clinical Conditions - Ovarian - Gynae. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Check for errors and try again. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Gravid uterus, with a singleton mobile early gestation, not specifically assessed. 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" Fertil Steril. It can also be seen in pregnancy, but seldom in a normal single pregnancy. Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. ADVERTISEMENT: Supporters see fewer/no ads. Initial ultrasound was normal. 12 ]. Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. Unable to process the form. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … Ovarian Torsion. Etiology and pathophysiology. Overall, the incidence of ovarian torsion during pregnancy is about 1 in 5000 pregnancies. 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. It usually occurs due to enlarged corpus luteum cyst. 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). {"url":"/signup-modal-props.json?lang=us\u0026email="}. The presence of arterial flow within the ovary suggest either an incomplete torsion, or … Uterine adnexal torsion: sonographic findings. However, heightened awareness and suspicion of this condition are needed for timely intervention. 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. The vascular pedicle is also engorged, and there is a small amount of free fluid in the Pouch of Douglas. 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. In this article, we discuss and illustrate the normal appearance and arterial flow … Radiology 1985;154(3):773–775. Ultrasound is the initial imaging modality of choice. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. 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 … Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? The … The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. 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. Magnetic resonance imaging demonstrated ovarian enlargement and edema. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. [Abstract/Free Full Text] Sonogr… Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. It is important to consider torsion when ovarian masses are discovered in pregnant patients with severe abdominal or pelvic pain . If not treated quickly, it can result in loss of an ovary. 1 week history of severe left iliac fossa pain. AJR Am J Roentgenol 1988;150(3):647–649. A corpus luteum is identified within this, as was seen on the preceding ultrasound (not shown). Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. 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. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. 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 during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. Introduction. Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy. It commonly occurs between the 6th and 14th weeks of pregnancy 1. Ultrasound is the initial imaging modality of choice. Without surgical intervention, the ovary may be lost; therefore, the diagnosis is important. Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Ovarian torsion is a medical emergency. (2017) Clinical practice and cases in emergency medicine. The classic clinical presentation overlaps that of appendicitis and includes nausea, vomiting, and pelvic pain. It is estimated that about 2.7% of surgical emergencies in women are comprised by ovarian torsion. A twisted pedicle, although not often detected on imaging, is … Known early pregnancy. 8 Ultrasound whirlpool sign in ovarian torsion. It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. 1 Ovarian torsion … Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. Sonogr… When present, it is often associated with severe pain. It is located in the pouch of Douglas and is enlarged to approximately 50cc. 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%). After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. 2009 Dec. 92(6):1983-7. Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. 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). 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. 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. Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. 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. Ectopic pregnancy occurs when a blastocyst abnormally implants outside the endometrium of the uterus. Pelvic pain for three days. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. 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. 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. Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. 12 weeks pregnant. It usually occurs due to enlarged corpus luteum cyst. 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). The color Doppler showed persistent arterial vascularity in the left ovary. ADVERTISEMENT: Supporters see fewer/no ads. No cysts or lesions. 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. 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. 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. Up to 80% of these cases occur in patients who are at the reproductive age. Check for errors and try again. 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. Unable to process the form. Fig. 51 Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. Ovarian torsion during pregnancy is an uncommon complication with high fetal mortality if not immediately treated. Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. 1. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. Ovarian hyperstimulation syndrome is a relatively rare condition. The incidence of ectopic pregnancy has increased from 0.37% of pregnancies in 1948 to approximately 2% of pregnancies in 1992 (,1). 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. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. 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). 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