P18.05: Many faces of whirlpool in patients with adnexal torsion

Abstract

Adnexal torsion is gynecological surgical emergency. Though it is mainly seen in reproductive age group, it can be seen in any age group. Early diagnosis is important to prevent loss of the adnexa / ovary. USG is the modality of choice for diagnosis. Whirlpool sign is the main diagnostic clue to the diagnosis of adnexal torsion and it is important to recognise this sign in its different appearances. We present our data of last 10 years in which there were 41 cases of adnexal torsion. 28 patients showed presence of whirlpool sign. We analysed the ultrasound findings of whirlpool sign in 28 cases. All patients were scanned by transvaginal USG and transrectal USG if unmarried. Patients were scanned on Philips HD11Xe & IU 22 colour Doppler machines. The presence of whirlpool sign, vascularity within the whirlpool, appearance of whirlpool was documented. The age at diagnosis ranged from 4-56 years. Out of 28 cases 16 showed flow within whirlpool, 12 showed no flow within whirlpool. 26 patients were operated and diagnosis confirmed. One patient refused surgery due to pregnancy and one patient was lost to follow up. In 4 patients isolated tubal torsion was found, 12 patients had only ovarian torsion, 9 patients had both ovarian and tubal torsion and in one patient paratubal cyst had undergone torsion (ovary and fallopian tubes were normal). Helpful USG features in diagnosing torsion are enlarged, edematous ovaries, multiple peripheral follicles, presence of concomitant ovarian mass, pelvic fluid, abnormal location of ovaries. Whirlpool sign is very specific for torsion. One should learn to look for different appearances of whirlpool, like-target appearance, either with or without a central echogenic dot; string of hypoechoic beads suggestive of dilated veins; appearance of a snail shell; or just a large hypoechoic mass. Presence of colour signal in whirlpool is important for prognostication. It should be remembered that search for whirlpool, at times can be difficult in presence of large masses and in a patient with pelvic pain.