Ovarian Edema Research Articles

The Sonographic Characteristics of Isolated Fallopian Tube Torsion

ObjectiveIsolated fallopian tube torsion (IFTT) presents a challenging preoperative diagnosis. This study investigated the specific sonographic characteristics of IFTT and compared them to the characteristics of ovarian and adnexal torsion. DesignRetrospective cohort study. SettingTertiary level gynecological ultrasound unit.: 225 women operated for suspected isolated ovarian, fallopian tube or adnexal torsion (ovary and tube) were included. InterventionsElectronic medical records of patients diagnosed with torsion at our ultrasound unit from 2001 to 2018 were retrieved. Inclusion criteria were women operated for suspicion of isolated ovarian, fallopian tube or adnexal torsion (involving both ovary and tube), with a preoperative sonogram performed in our tertiary level gynecologic ultrasound unit. Patients operated after a sonographic examination in the emergency department were excluded. MeasurementsPatients were divided into 4 groups according to their laparoscopic diagnosis: IFTT, ovarian torsion, adnexal torsion or no torsion.The sonographic characteristics of the groups were compared and the diagnosis was confirmed according to laparoscopy findings. Main resultsIFTT was reported in 28/225 (12.4%) cases. Ovarian volume was significantly lower in IFTT (29.2 ± 44 cm3) compared to ovarian torsion (111 ± 143 cm3, p=.037). There were fewer cases of ovarian edema in IFTT compared to ovarian torsion (12/22 (54.5%) vs. 54/63 (85.7%) respectively, p=.001). IFTT was associated with paraovarian cyst significantly more often than with ovarian torsion (13/24 (54.2%) vs. 4/75 (5.3%), respectively; p=.003). There was no difference between whirlpool sign and location in all forms of torsion. The sensitivity, specificity, Positive predictive value and Negative predictive value for IFTT were 88.4%, 83.3%, 95.8% and 62% respectively. ConclusionIFTT has distinct sonographic characteristics, including normal ipsilateral ovary, paraovarian cyst, and whirlpool sign. Awareness of these features may improve the diagnosis of IFTT and promote faster and more efficient treatment. Further studies are needed to establish these characteristics.

A rare case of bilateral massive ovarian oedema masquerading as torsion

A rare case of bilateral massive ovarian oedema masquerading as torsion

A Case Report of Massive Ovarian Edema Expressing Ovarian Torsion

Introduction: Massive ovarian edema is a rare clinical entity arising from the ovaries, and it poses a significant clinical challenge as it can be easily mistaken for neoplasm. The entity is not well known by clinicians and radiologists. This is a case report of a young patient of 16 diagnosed as massive ovarian edema. Case Presentation: Patient aged of 16 admitted for acute pelvic pain who benefited from ultrasound finding a large cystic and edematous right ovary with suspicion of sub torsion. A MRI was done and concluded to a massive edematous ovary which was firstly treated by symptomatic management with goode volution. 2 weeks later the patient came with a huge pain. Emergency laparotomy was done with salpingo ovariectomy. Conclusion: Recognition of massive ovarian edema is of great importance to prevent unnecessary salpingo ovariectomy in young patients. It can hide adnexa torsion which should be managed on time to avoid ovarian necrosis.

Fertility preserving management of ovarian torsion

To analyze characteristics of acute and chronic ovarian torsion, review treatment recommendations, and present possible surgical techniques for fertility preservation in young women. Literature review and demonstration of perioperative management of ovarian torsion using radiologic images and intraoperative video footage. Ovarian torsion is mostly mentioned in context of gynecologic emergencies, where acute ovarian torsion with arterial obstruction leads to ovarian ischemia and necrosis. However, ovarian torsion can also occur as a partial or intermittent torsion with venous and lymphatic obstruction, followed by ovarian swelling. In both cases, surgical management of ovarian torsion commonly includes oophorectomy, although leading guidelines recommend preservation of the ovary. We here aimed to raise awareness for the clinical features of ovarian torsion and demonstrate adequate perioperative management, thereby avoiding surgical overtreatment in young women. Medical University of Vienna, Department of Obstetrics and Gynecology. We present a case of acute ovarian torsion with a consequently ischemic ovary as well as a case of chronic ovarian torsion with related massive ovarian edema. The patients included in this video gave consent for publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.), and other applicable sites. Laparoscopic management with detorsion of the torquated ovaries, cystectomy on an ischemic ovary and oophoropexy to the pelvic side wall and utero-ovarian ligament to prevent recurrence. Postoperative relief of pain and normalization of ovarian size and morphology on ultrasound imaging. The current cases show successful conservative surgical management of ovarian torsion, hence preserving hormonal function and fertility in young women. Although it is recommended to preserve fertility in young women affected by ovarian torsion, surgical overtreatment by means of oophorectomy is still common in clinical routine. Increasing awareness for the clinical characteristics of acute and chronic ovarian torsion, as well as for the importance of preservation of the ovary, is crucial. We therefore believe that ovarian torsion and its surgical management deserve increased attention in the future.

Role of scrape cytology smear preparation in the diagnosis of ovarian masses-utility and pitfalls.

Scrape cytology technique is useful for rapid intraoperative diagnosis of ovarian mass lesions that acts as an adjunct to frozen section examination. Though ovaries can be accessed by laparoscopy and USG guided FNAC, there are controversial reports regarding the safety of these procedures. The present study has been designed to evaluate the role of scrape cytology in a variety of ovarian mass lesions. To study the cyto-morphology of ovarian mass lesions and to evaluate the role of scrape cytology technique in correctly diagnosing the ovarian lesions taking histopathological diagnosis as gold standard. This is a prospective observational study done on 61 ovarian mass lesions as received from the Obstetrics and Gynecology department of our Institution. Out of 61 cases, 58 (95.08%) cases were correctly diagnosed with respect to categorization and typing. The age ranged from 14 to 65 years with the mean age being 38.1 years. On histopathology, out of 61 cases, 39 (63.93%) were epithelial along with sub categorization of benign, borderline, and malignant, 13 (22.9%) were germ cell tumors, 5(8.19%) were sex cord stromal tumors, 3 (4.91%) were hemorrhagic cysts and the remaining 1 (1.63%) was massive ovarian edema. Thus, on comparing with histopathology, the sensitivity and specificity of scrape cytology technique were 93.55% and 96.67%, and the diagnostic accuracy was 95.08%. Scrape cytology of ovarian lesions can give quick and reliable results. Also, proper training of cytopathologists chiefly regarding the sampling technique, gross presentation of ovarian lesions and interpretation of scrape cytology smears is needed. Further studies to provide standard guidelines and reporting criteria will prove to be helpful.

Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis.

To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A Scoring System Developed by a Machine Learning Algorithm to Better Predict Adnexal Torsion

To establish a clinically relevant prediction score for the diagnosis of adnexal torsion (AT) of women operated on for suspected AT. A retrospective cohort between 2014 and 2021. A large tertiary teaching medical center. Women who underwent urgent laparoscopy for suspected AT INTERVENTIONS: Analyses included univariate and multivariable models combined with the machine learning (ML) Random Forest model which included all information available about the women and reported the accuracy of the model and the importance of each variable. Based on this model we created a predictive score and evaluated its accuracy by receiver operating characteristic (ROC) curve. A total of 503 women were included in our study, of which 244 (49%) were diagnosed with AT during the surgery and 44 (8.8%) cases of necrotic ovary were found. Based on the Random Forrest and multivariable models the most important pre-operative clinical predictive variable for AT was vomiting, left-side complaints, and concurrent pregnancy; cervical tenderness and urinary symptoms decreased the likelihood of surgically confirmed AT. The most important sonographic findings were ovarian edema and decreased vascular flow; hemorrhagic corpus luteum decreased the likelihood of surgically confirmed AT. The accuracy of the Random Forest model was 71% for the training set and 68% for the testing set, and the area under the curve for the multivariable model was 0.75 (95%CI 0.69-0.80). Based on these models we created a predictive score with a total score that ranges from -4 to 12 points. The area under the curve for this score was 0.72 (95%CI 0.67-0.76), and the best cutoff for the final score was > 5 points with sensitivity/specificity/PPV/NPV of 64%/73%/70%/67%. Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of women with suspected AT. ML in this setting has no diagnostic/predictive advantage over the performance of logistic regression methods. Further prospective studies to strengthen the accuracy of this model are needed.

Postoperative Observation of Spaying with the Silicon Ring on the Ovaries in Heifers: A Retrospective Study in 28 Cases.

Although spaying prepubertal heifers has routinely been conducted to control cattle herd and improve meat quality, understandings of the postoperative changes following new spaying methods with the silicon ring on the ovaries via colpotomy remain limited. Therefore, as a retrospective study, 28 cases of spayed heifers were reviewed for postoperative changes after employing this method, with inclusion criteria including complete medical records for clinical observation, ultrasonography, measuring reproductive hormones, and tracking slaughter records. No mortality and heat signs at the pubertal age postoperatively occurred in spayed animals. On ultrasonography during rectal examination, the ovaries were enlarged without any folliculogenesis from one week, while massive ovarian edema appeared from two weeks, and ovaries were no longer palpable at four weeks post-surgery. In hormones, whereas estrogen and progesterone levels did not change from prepubertal to pubertal age in spayed animals, luteinizing hormone levels progressively increased during this period and reached a higher level at pubertal period than unspayed controls. Although carcass weight and yield were similar between groups upon slaughter at pubertal age, the spayed animals presented higher carcass quality (marbling degree) than that of controls. These results may contribute to develop herd management strategies, including control of estrus in cattle.

Rethinking ovary preservation by adnexal torsion reversal in adolescents: a case of delayed diagnosis

BackgroundThis article discusses the management of an adolescent woman with a delayed diagnosis of adnexal torsion (AT) whose ovaries were successfully preserved.Case presentationThe patient was a 14-year-old female teen admitted with the chief complaint of lower abdominal pain for 3 days and worsening pain for 2 days. Magnetic resonance imaging suggested a high possibility of torsion in the anterosuperior uterine mass and was accompanied by severe ovarian edema, bleeding, and enlargement. Intraoperatively, the left fallopian tube was characterized by thickening and torsion and appeared blackish purple. The left fallopian tube paraovarian cyst was about 20 cm in size, and the left adnexa was twisted 1080° along the left infundibulopelvic ligament (suspensory ligament of the left ovary). The left ovary appeared blackish purple, with an enlarged diameter of about 10 cm. At the request and with the informed consent of the patient’s parents, we preserved the left ovary and removed the left fallopian tube. The results of the endocrine, ultrasound, and tumor marker tests were normal 1 month after surgery. Follicles and blood flow signals seen in ultrasound examinations indirectly proved the successful preservation of the left ovary in the follow-up.ConclusionsOur attempt to preserve the ovaries in an adolescent with a delayed diagnosis of AT was successful.

Ultrasonographic scoring system for the diagnosis of adnexal torsion.

To establish the utility of an ultrasonographic scoring system for the diagnosis of adnexal torsion. We retrospectively analyzing 358 adnexal torsion cases. Using Pearson's χ2 test we determined whether ultrasonographic signs were significantly associated with adnexal torsion. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of the system. Ultimately by using binary logistic regression we established a precise and convenient scoring system. The torsion score was based on five criteria that were identified to be independently associated with adnexal torsion: (1) abnormal position of the index adnexa (odds ratio [OR], 2.311); (2) presence of a mass or cyst (OR, 3.495); (3) unilateral ovarian enlargement (OR, 3.051); (4) vascular pedicle twisting (OR, 2.105); and (5) peripheral hypervascularity of the corpus luteum with ovarian edema(encapsulating cyst sign) (OR, 4.164).patients with torsion who scored 0, have a predicted diagnosis rate of 20.9%; patients whose scores were 1,2 have a predicted probability of 41.8% and 66.15%, respectively. For patients with torsion scores of 3, 4, and 5, predicted diagnosis rates were 84.16%, 93.52%, and 98.27%, respectively. The ultrasonographic scoring system is feasible and precisely diagnoses adnexal torsion using ultrasound.

Case report of ovarian edema – A diagnostic dilemma

Ovarian edema is a rare solid tumor-like condition, usually seen in women of reproductive age. It occurs due to the accumulation of interstitial fluid in the stroma of the ovary, because of partial or complete torsion of the ovary causing interference with the venous or lymphatic flow but not the arterial flow. It is a misleading condition, difficult to diagnose visually and can lead to oophorectomy resulting in loss of fertility and hormonal function. We report the case of a 13-year-old girl who presented with acute abdomen. The ovary gave a visual impression of malignancy at laparoscopy and a frozen section was done. The frozen section ruled out malignancy and reported as ovarian edema which is a benign condition. The patient underwent ovarian detorsion and the ovary was conserved. Ovarian conservation is important in young girls and oophorectomy should not be done on visual suspicion. When possible frozen section should be done to confirm a benign pathology intraoperatively before taking a decision of surgical removal of the ovary.

A case of recurrent massive ovarian edema manifesting as acute abdomen first operated via laparoscopic surgery

A case of recurrent massive ovarian edema manifesting as acute abdomen first operated via laparoscopic surgery

VP04.05: Diagnostic accuracy of transvaginal ultrasound in adnexal torsion

To assess the diagnostic accuracy of transvaginal ultrasound for the diagnosis of adnexal torsion and to describe ultrasound characteristics of adnexal torsion. This is a prospective study. 90 patients with clinical symptoms of adnexal torsion were evaluated by transvaginal ultrasound based on six suggestive signs (abnormal ovarian location, ovarian edema, whirlpool sign, abnormal ovarian blood flow, distended fallopian tube and fluid around the ovary). The findings were compared with surgical results. Among 90 patients with 103 ovarian tumours, 55 were operated and 34 were confirmed to have adnexal torsion (29 cases were correctly diagnosed and five cases were missed). The sensitivity, specificity, positive predictive value and negative predictive value of sonography for diagnosing adnexal torsion are: 85.3%, 84.1%, 72,5% and 92.1%, respectively. In addition, the sensitivity and specificity of the suggestive signs are: abnormal ovarian location: 29.4%, 95.5%; ovarian edema: 35.3%, 95.6%; whirlpool sign: 76.5%, 87%; abnormal ovarian blood flow: 41.2%, 98.5%; distended fallopian tube: 41.2%, 84.1%; fluid around the ovary: 91.2%, 36.2%. Transvaginal ultrasound is an excellent tool to evaluate patients with suspected adnexal torsion. Dermoid or unilocular tumour, loss of vascular signal and whirlpool sign are independent predictive factors of adnexal torsion.

Massive ovarian edema masquerading as an androgen-secreting tumor

ObjectiveTo highlight the management of massive ovarian edema in young reproductive-age women.DesignA case report of a healthy female with clitoromegaly and elevated androgen levels secondary to massive ovarian edema.SettingReproductive Endocrinology and Infertility Department of an academic hospital.PatientA healthy 20-year-old woman who presented for routine gynecological care and was found to have a 2-cm clitoromegaly and elevated androgen levels.InterventionsThe patient underwent a diagnostic laparoscopy and right oophorectomy.Main Outcome MeasuresMeasurement of androgen levels.ResultsFinal pathology showed massive edema of the ovary with no evidence of malignancy or androgen-secreting tumor cells. In addition, resolution of the elevated androgen levels was observed.ConclusionsMassive ovarian edema due to asymptomatic subacute torsion should be included in the differential diagnosis of reproductive-age patients who present with ovarian mass and hyperandrogenemia within the tumor range. Although not performed in our case, conservative management that involves detorsion, ovarian biopsy, and oophoropexy to prevent a recurrence should be the treatment of choice.

Ovarian Torsion in Adolescents with and without ovarian mass: ACross-sectionalStudy.

The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT). Retrospective cross-sectional study. Gynecology Department at Tepecik Education and Reseach Hospital, Izmir, Turkey. Adolescent girls who received surgery for OT between March 2012 and October 2020 in our institution. The patients were divided into 2 groups according to the presence or absence of an ovarian mass and compared. Demographic and clinical characteristics, imaging findings, surgery, and pathology reports of the patients were obtained. Differences in initial symptoms, ultrasound findings, the diagnostic process, and the degree of torsion in patients with and without ovarian mass. Seventy-six patients were diagnosed with OT. Of the 76 patients, 41/76 (53.9%) had an ovarian mass (OTwM), and 35/76 (46.1%) had no pathology (OTnP). The admission to surgery interval was longer in the OTnP group (P=.03). Ultrasound findings of ovarian edema and the appearance of free fluid were significant in the OTnP group (P=.001). The largest dimension of the nontorsion ovary in the OTnP group was greater than in the OTwM group (P=.03). In addition, it was found that torsion more than 360° was more common in the OTnP group than in the OTwM group (24/35, 68.5% vs 41/18, 43.9%; P=.03). In symptomatic adolescents without an ovarian mass, the presence of follicle peripheralization suggesting ovarian edema on ultrasound and the presence of free fluid in the abdomen are important in terms of suspicion of torsion for clinicians. In addition, the degree of torsion was increased in these patients.

Accurate Diagnosis of Adnexal Torsion—Not Only for Expert Sonographers

The aim of the study was to evaluate the clinical and sonographic parameters associated with a correct or incorrect diagnosis of adnexal torsion made by resident/attending physicians who are not expert sonographers. A retrospective study design included women who presented to the Emergency Department (ED) of a tertiary medical center between 2010 and 2019 with acute lower abdominal pain, who were subsequently diagnosed laparoscopically with adnexal torsion. Women who were correctly diagnosed in the ED by an obstetrician-gynecologist who was not an expert sonographer were compared for clinical and sonographic parameters with women who were initially incorrectly diagnosed and underwent a second ultrasound examination by an expert sonographer following admission. Of 118 women with surgically proven adnexal torsion, 76 were correctly diagnosed in the ED and 42 were initially incorrectly diagnosed. The correctly diagnosed group was characterized by a significantly shorter mean time from admission to surgery, higher rate of vomiting, shorter duration of abdominal pain, and higher rate of prior torsion (P< .05). Physicians who made the correct diagnosis utilized more sonographic parameters than those who did not, namely ovarian size, ovarian edema, and Doppler flow. The correctly diagnosed group had a higher rate of bluish-black (ischemic) adnexa at laparoscopy, but a higher rate of recovery following detorsion. Physicians in the ED should be alerted to the need to address some basic sonographic features when adnexal torsion is suspected. The diagnostic accuracy of adnexal torsion can be improved by utilizing simple sonographic markers, even in the ED setting.

49. Applicability of an Established Composite Scoring System for Predicting Adnexal Torsion in African American Pediatric Patients

<h3>Background</h3> Adnexal torsion can be difficult to diagnose. A prospective 2017 study focusing on the pediatric and adolescent population showed great promise in the development of an ultrasound-based scoring system used to predict this condition. However, the patient population was almost homogenously Caucasian, limiting its applicability in more ethnically diverse settings. We sought to clarify whether this scoring system maintained its validity when used in a primarily African American population, and in patients with a BMI >25. <h3>Methods</h3> A retrospective chart review was performed to identify cases of pediatric ovarian torsion, confirmed by laparoscopy, over the course of 10 years at a tertiary referral center. Inclusion criteria were: pediatric and adolescent girls between the ages of 0-21, and surgically proven cases of torsion diagnosed by ultrasound imaging. Exclusion criteria included: pregnancy of unknown location, preoperative imaging with CT only, or other suspected preoperative diagnoses (e.g. appendicitis, hemorrhagic cyst). Established clinical and ultrasound predictors of torsion were identified through chart and image review for their correlation to adnexal torsion. Using the established scoring system, a score was then applied to these confirmed torsion cases to determine whether or not the score would have successfully identified the torsion. <h3>Results</h3> A total of 53 cases of surgically proven ovarian torsion were found meeting the above criteria. Of the patients included 25% were premenarchal, while the remainder were postmenarchal. Approximately 60% were African American, 10% were Hispanic, and 30% were Caucasian. The average BMI across all ethnicities was 29. Applying the scoring system to these known cases, we found that our post hoc calculated scores correlated with the predictors previously identified. Primarily; adnexal mass, ovarian edema, leukocytosis, nausea/vomiting, adnexal ratio, and ovarian volume were all significantly associated with ovarian torsion (p < 0.05). Temperature, absence of arterial/venous flow, peripheral cysts, and pelvic free fluid were not associated with ovarian torsion. If applied prospectively to our patient population, over 90% of cases of confirmed torsion could have been identified by the composite score discussed above. <h3>Conclusions</h3> Widespread use of a non-invasive scoring system to predict adnexal torsion has the potential to significantly improve the timely assessment and management of young women with this condition. Our study suggests that a previously published composite score for torsion, using clinical and ultrasound findings, can successfully be used to predict torsion in African American and high BMI premenarchal and postmenarchal adolescents.

English

BACKGROUND Ovarian torsion occurs when the ovary twists on its fibrovascular pedicle resulting in vascular compromise. Initially, there is twisting of the ovary, fallopian tube, or both structures, causing venous, lymphatic and arterial compromise with resultant ovarian oedema and adnexal enlargement. We wanted to determine the most common ultrasonography (USG) and magnetic resonance imaging (MRI) findings in surgically proven cases of ovarian torsion. METHODS We present a series of cases obtained on retrospective review of USG and MRI findings in 10 surgically proven cases of ovarian torsion between June 2018 to June 2020 in the Department of Radiology, MVJ Medical College &amp; Research Hospital, Hoskote. RESULTS Significant enlargement of the ovary with size ranging from 5 to 15 cms with peripherally displaced follicles and free fluid in the pelvis in noted in all the patients on USG and MRI. Other common MRI features include ‘twisted vascular pedicle’ sign seen in 7 (70 %) cases, areas of haemorrhage within the ovarian stroma in 7 (70 %) cases and abnormal ovarian enhancement in 9 (90 %) cases. CONCLUSIONS Ultrasound and MRI are the main diagnostic imaging modalities prior to treatment. Improved detection and characterisation of pelvic mass contributes to better diagnostic accuracy. The most common findings in US and MRI features of ovarian torsion include ovarian enlargement with peripherally displaced follicles and free fluid in pelvis. Other common MRI features include ovarian haemorrhage, twisted vascular pedicle, abnormal ovarian enhancement and deviation of the uterus towards the same side. KEYWORDS Ovarian torsion, USG, MRI

Adnexal Torsion: Review of Radiologic Appearances.

Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. Online supplemental material is available for this article. ©RSNA, 2021.

A case of massive ovarian edema on laparoscopic conservative surgery

A case of massive ovarian edema on laparoscopic conservative surgery