Ovarian Torsion
Ovarian torsion is an infrequent though important gynecological pathology.
It is sometimes caused by mass or cyst which causes the ovary to spin on its pedicle. The larger the lesion the higher the risk.
It is usually a unilateral process, 60% on occur in right ovary.
Presentation
Sudden onset of unilateral lower abdominal pain
Lower back pain
Nausea and vomiting present in 70% of cases
Ovarian salvage rate
10%in adults
27%in pediatrics
Sonographic findings
Unilaterally enlarged ovary
Peripherally displaced follicles due to edema
Twisted pedicle (not always seen)
Free fluid
little or no intra-ovarian venous flow
absent arterial flow (poor prognostic sign)
absent or reversed diastolic flow
normal vascularity does not exclude intermittent torsion
normal Doppler flow can also occasionally be found due to dual supply from both the ovarian and uterine arteries
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