No cysts or lesions. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. Paraovarian cysts account for ~10-20% of adnexal masses and can be complicated by rupture, torsion, or hemorrhage. Ultrasound features are consistent with left paraovarian cyst with acute left ovarian torsion and coexisting gravid uterus with normal early pregnancy of 8 weeks. Most cases are caused by dermoid and functional ovarian cysts. 12 weeks pregnant. The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. The … 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. Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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. 1 (2): 108-110. The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology M. Rincon Maternal and Fetal Medicine and Radiology, Oregon Health & … {"url":"/signup-modal-props.json?lang=us\u0026email="}. Fig. It usually occurs due to enlarged corpus luteum cyst. Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy. Young R, Cork K. Intermittent Ovarian Torsion in Pregnancy. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Ultrasound is the initial imaging modality of choice. 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. Initial ultrasound was normal. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. It is caused by hormonal overstimulation by hCG, and is therefore usually bilateral. If not treated quickly, it can result in loss of an ovary. 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. 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). It commonly occurs between the 6 th and 14 th weeks of pregnancy 1. 12 ]. It commonly occurs between the 6th and 14th weeks of pregnancy 1. Although mortality decreased by nearly 90% from 1979 to 1992, ectopic pregnancy remains the leading cause of death during the first trimester of pregnancy, with a 9%–14% mortality rate (,1,,2). A twisted pedicle, although not often detected on imaging, is … 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%). Torsion of the ovary is a true gynecological emergency, and up to one-fifth of ovarian torsion occurs during pregnancy. Acute ovarian torsion is a gynecological emergency and should be excluded on ultrasound. MRI and ultrasound appearance of ovarian torsion in a 12 week pregnant patient. The US appearance of the ovary raised high suspicion of left ovarian torsion. [Abstract/Free Full Text] Warner MA, Fleischer AC, Edell SL, et al. 2009 Dec. 92(6):1983-7. 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. Edematous, T2 hyperintense left fallopian tube is identified, best appreciated on the sagittal T2 images. 1. Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. Magnetic resonance imaging demonstrated ovarian enlargement and edema. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Although this sign is specific for ovarian torsion, yet it had been variably reported as seen in 13–88% of patients with ovarian torsion , , . The incidence of ectopic pregnancy has increased from 0.37% of pregnancies in 1948 to approximately 2% of pregnancies in 1992 (,1). [Abstract/Free Full Text] 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. Ovarian Torsion. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. Ultrasound is the initial imaging modality of choice. Fertil Steril. It can also be seen in pregnancy, but seldom in a normal single pregnancy. Ovarian hyperstimulation syndrome is a relatively rare condition. 51 However, heightened awareness and suspicion of this condition are needed for timely intervention. Introduction. (2017) Clinical practice and cases in emergency medicine. 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). Known early pregnancy. Left ovary is markedly edematous, T2 hyperintense with T2 shine through on DWI/ADC. Normal right ovary, located posterolaterally relative to the uterus. However, rendering an accurate diagnosis of ovarian torsion is challenging. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy. The classic clinical presentation overlaps that of appendicitis and includes nausea, vomiting, and pelvic pain. In this case, the cyst arises near the left ovarian pedicle suggestive of paraovarian cyst. Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. 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" Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [ 1 ??? 1 Ovarian torsion … The color Doppler showed persistent arterial vascularity in the left ovary. Sonogr… ADVERTISEMENT: Supporters see fewer/no ads. 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. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. 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. Interestingly, arterial flow with normal waveforms was detected in both the ovary and its pedicle, suggesting either an incomplete torsion, or an element of torsion-detorsion. When present, it is often associated with severe pain. Unable to process the form. It is important to consider torsion when ovarian masses are discovered in pregnant patients with severe abdominal or pelvic pain . Check for errors and try again. Uterine adnexal torsion: sonographic findings. 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. 1 week history of severe left iliac fossa pain. The presence of arterial flow within the ovary suggest either an incomplete torsion, or … The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, edema, and hemorrhage. Ectopic pregnancy occurs when a blastocyst abnormally implants outside the endometrium of the uterus. Without surgical intervention, the ovary may be lost; therefore, the diagnosis is important. It usually occurs due to enlarged corpus luteum cyst. 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. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Gravid uterus, with a singleton mobile early gestation, not specifically assessed. 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. Etiology and pathophysiology. It is relatively uncommon at an incidence of approximately 1/1000 pregnancies, but may affect upwards of 16% of pregnancies achieved through ovarian hyperstimulation. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. Ovarian torsion affects approximately 7% of known ovarian masses in pregnancy . Current ultrasound confirms a edematous, enlarged left ovary (volume 54cc) with multiple small follicles and a corpus luteum displaced to the periphery. The vascular pedicle is also engorged, and there is a small amount of free fluid in the Pouch of Douglas. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. 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. In this article, we discuss and illustrate the normal appearance and arterial flow … Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. 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. 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