Obstetrics & Gynecology International Journal. The goal of the ED physician is to diagnose torsion in a timely fashion in an attempt to preserve ovarian function and viabili… Comparison with the asymptomatic contralateral side is typically very helpful. Table 2 presents the frequency of the various sonographic signs associated with ovarian torsion in women with and without evidence of ovarian torsion on laparoscopy. 8 Ultrasound whirlpool sign in ovarian torsion. We recommend that sonographic evaluation retain its place as the first‐line imaging study for female patients with lower quadrant pain. [1,17] Adnexal torsion more commonly occurs in women of reproductive age, but this gynecological emergency rarely affects postmenopausal women at approximately 2.7%. Methods: This was a multi-reader, blinded, retrospective review performed at a single academic center from 2012 to 2018. The comparison between the serum level of interleukin-6 in women with acute ovarian torsion and other causes of lower abdominal pain. Ovarian torsion is a medical emergency. Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain. Association between peak estradiol levels and ovarian torsion among symptomatic patients receiving gonadotropin treatment. While classically the pain is sudden in onset, this is not always the case. There was considerable variation in the accuracy of the sonographic diagnosis among the operators (mean ± SD, 78.8% ± 16.0%; range, 60.0%–100%), although the differences did not reach statistical significance (odds ratio, 0.9; 95% confidence interval, 0.2–4.7; Table 4). Journal of Pediatric and Adolescent Gynecology. Handbook of Consult and Inpatient Gynecology. In conclusion, the diagnosis of ovarian torsion remains a clinical and occasionally an imaging enigma. Prompt diagnosis can be further complicated in low-risk populations such as young children. Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway. The diagnosis of ovarian and adnexal torsion remains challenging. 2 3 Twisted adnexal masses are often midline, positioned cranial to the uterine fundus. The Diagnosis and Management of the Acute Abdomen in Pregnancy. https://www.saem.org/.../m4-curriculum/group-m4-approach-to/ovarian-torsion Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Analysis of Clinical and Ultrasound Determinants of Adnexal Torsion in Children and Adolescents. Our main findings were as follows: (1) sonographic diagnosis of ovarian torsion had overall accuracy of 74.6%; (2) the most frequent laparoscopic finding in cases of an erroneous sonographic diagnosis of ovarian torsion was a hemorrhagic corpus luteum; (3) abnormal ovarian blood flow and free fluid were the most accurate isolated sonographic signs of ovarian torsion; (4) a substantial proportion of women had ovarian torsion despite the presence of normal ovarian blood flow, lack of ovarian enlargement, and lack of an ovarian cyst or mass on sonography; and (5) combinations of sonographic signs had higher specificity values and PPVs for ovarian torsion. The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs. Please check your email for instructions on resetting your password. The right ovary is still enlarged with a volume of 22cc but considerably smaller (previously 53cc), and comparable to the left (which has a volume of 17cc), with >30 follicles seen in each ovary. However, the clinical findings of ovarian torsion frequently overlap with other causes of pelvic pain and adnexal masses, including hemorrhagic cysts and abscesses. Methods: A retrospective review was performed of all premenarchal patients ≥3 years of age with a normal pelvic ultrasound between January 2016 and January 2019. Also it appeared to be useful in detection of tube thickening and twisted pedicle which had different patterns increasing the reliability of ovarian torsion diagnosis. In cases in which the clinical presentation is inconclusive, using combinations of sonographic signs, including Doppler evaluation, in the assessment can increase the specificity of the sonographic diagnosis. Other common MR features included abnormal poor ovarian enhancement. Surgically Managed Ovarian Masses at the Royal Children’s Hospital, Melbourne –19 Year Experience. The ovarian volume ratio, ovarian width, and Doppler flow were all evaluated as potential predictive variables for ovarian torsion (Table 3). Sonographic Diagnosis of Ovarian Torsion: Accuracy and Predictive Factors. All of the statistical tests were 2 tailed, and differences were considered significant at P < .05. Multimodality imaging review for suspected ovarian torsion cases in children. The study retrospectively enrolled 14 incidences of surgically confirmed ovarian torsion. Chemical peritonitis in pregnancy: An unusual presentation and review of the literature. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. 1 – 4 It may signal either a necrotic adnexa or an unimpaired vascularly twisted ovary. Retrospective review of patients’ radiological images and reports was conducted looking for the presence of imaging features of ovarian torsion. Evaluation and Management of Adnexal Masses. The most common findings in US and MRI were edematous enlarged ovary with peripherally displaced follicles and pelvic collection. Dopplersonographie in Geburtshilfe und Gynäkologie. Basing assessments on multiple sonographic signs, including Doppler evaluation, increases the diagnostic specificity. The increase in ovarian volume begins after 6 years of age (, Table). There was no significant difference between women with and without laparoscopic evidence of torsion for the frequency of edematous ovarian tissue, an abnormal location of the ovary, bleeding within the ovarian tissue, ovarian enlargement, the presence of an adjacent distended tube, and an ovarian cyst or mass on sonography. Transvaginal sonogram showing a large edematous homogeneous circumscribed mass surrounded by free fluid. Figures 1 and 2 show examples of typical sonographic signs. Ovarian cyst torsion in reproductive age group-changing trends in management 4. It happens … Cases of CLOE that were misdiagnosed as torsion and cases of ovarian torsion without a lead-point mass were analyzed. Ovarian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2.7% to 3%. 1. A combination of 2 or more sonographic signs was associated with a higher specificity and PPV for ovarian torsion (up to 100% for most combinations of ≥3) but a lower sensitivity (10.6%–55.3% for combinations of ≥3) and NPV (27.6%–40.0%). Some signs were associated with relatively high sensitivity (ovarian edema, abnormal ovarian blood flow, and ipsilateral ovarian enlargement), whereas others were characterized by relatively high specificity (free fluid around the ovary or in the Douglas pouch, an ovarian cyst or mass, and an abnormal location of the ovary; Table 3). Fig. Ovarian volume has been reported to be a common finding in ovary torsion [9]. To determine which of the sonographic factors best predicted ovarian torsion, as well as to assess the effect of other factors (ie, sonographic approach, side of torsion, and operator), on the accuracy of the diagnosis of ovarian torsion, we performed a multivariate logistic regression analysis with ovarian torsion on laparoscopy as the dependent variable and the ultrasound operator (5 physicians in the ultrasound unit), side of suspected torsion (left versus right), and sonographic approach (transabdominal versus transvaginal) as the independent variables, in addition to the different sonographic signs (Table 4). However, given the low NPV of some of the sonographic signs, ovarian torsion should be considered even when the typical sonographic signs are absent, especially if the clinical presentation is suggestive. Mass lesion volume. If 1 or more of the signs included in a given combination was absent, than the result of the dichotomous test based on this combination was negative. Diagnostic Accuracy of Neutrophil/Lymphocyte Ratio, Red Cell Distribution Width and Platelet Distribution Width in Ovarian Torsion. Emergency Medicine Clinics of North America. Key Clinical Predictors in the Early Diagnosis of Adnexal Torsion in Children. Cases of CLOE that were misdiagnosed as torsion and cases of ovarian torsion without a lead-point mass were analyzed. The diagnostic accuracy was largely affected by the ultrasound operator (mean ± SD, 78.8% ± 16.0%; range, 60.0%–100%). Journal of Assisted Reproduction and Genetics. Number of times cited according to CrossRef: Added value of MRI for the diagnosis of adnexal torsion in children and adolescents after inconclusive ultrasound examination. Isolated Fallopian Tube Torsion: A Unique Ultrasound Identity or a Serial Copycat?. The aim of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of the various sonographic signs. Ovarian torsion was identified in 47 cases (74.6%). The clinical management of ovarian torsion: case series of 66 patients. Ovarian torsion is the partial or complete rotation of the ovary on the ligamentous support (infundibulopelvic ligament and the utero-ovarian ligaments) within the abdomen, often critically limiting the blood supply to the ovary. Multivariate stepwise (forward likelihood ratio) logistic regression analysis was used to determine which of the sonographic factors best predicted ovarian torsion as well as to assess the effect of other factors (ie, sonographic approach, side of torsion, and operator) on the accuracy of the diagnosis of ovarian torsion. Treatment is traditionally surgical removal of the ovary or adnexum, however, there is increasing evidence for conservative surgery, such as de‐torsion and oophoropexy, particularly in younger women. Ovarian torsion rarely presents with classic symptoms. Ovulation is the part of your menstrual cycle when your ovary releases an egg. [1] Four women (6.3%) had no abnormal findings on laparoscopy. Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue 2. The ovary shows one or more cystic follicles with marked thickening of the cyst wall; it is usually diffusely enlarged.13,14 The most consistent finding is a unilateral enlarged ovary. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? During the years covered by the study, sonographic examinations were performed by 5 senior physicians who are ultrasound specialists. Learn more. Gynecologic Etiologies of Abdominal Pain in Pregnancy. In postmenarchal girls, the ovarian volume averages 8 cm 3 (range, 2.5–20 cm 3). Ovarian torsion is one of the most common gynecologic emergencies encountered by Emergency Medicine physicians and remains a must not miss diagnosis. By continuing you agree to the use of cookies. JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY. Keywords:Ovarian torsion, ultrasound, CT, MRI, prepubertal girls, adnexa. Bedside Ultrasonography for Obstetric and Gynecologic Emergencies. In this article, we discuss and illustrate the normal appearance and arterial flow … The data collected at each examination were directly saved to the database, according to departmental procedures, including the uterine and ovarian size and the presence of free fluid in the Douglas pouch. Ovarian Torsion •Partial or complete rotation of the ovarian pedicle on its axis which compromises the lymphatic and venous ... More common in childhood/reproductive years with increased risk during pregnancy. … If you do not receive an email within 10 minutes, your email address may not be registered, Spectrums and Outcomes of Adnexal Torsion at Different Ages. The study included 63 women attending an ultrasound unit of a tertiary obstetrics and gynecology department in 2002 through 2008 who had suspected ovarian torsion on sonography and subsequently underwent laparoscopy. The absence of typical sonographic signs does not rule out ovarian torsion, especially when the clinical presentation is suggestive. Initially, all possible combinations of the 8 sonographic signs were evaluated. The cause of torsion has been suggested to be excessively elongated utero-ovarian ligament or the increased volume and weight of an adnexal mass. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques. The sensitivity of the individual signs ranged from 36.2% to 85.1%, and the specificity ranged from 18.8% to 87.5%. Sixty‐three women met the study criteria. Other ultrasound features of torsion include high-resistance arterial flow with loss of venous flow, twisted vascular pedicle, and corkscrew vessels. Longitudinal sonogram showing an enlarged ovary with several small peripherally located follicles. Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management. Peer review under responsibility of The Egyptian Society of Radiology and Nuclear Medicine. Sonography has advanced tremendously in recent years. According to our data, in the setting of an ultrasound unit and a team of ultrasound specialists, the sonographic diagnosis of ovarian torsion had high accuracy compared with previous reports. We use cookies to help provide and enhance our service and tailor content and ads. Ultraschall in der Medizin - European Journal of Ultrasound. Peripheral hypervascularity of the corpus luteum with ovarian edema (CLOE) may decrease false positive diagnoses of ovarian torsion. Accuracy of Pelvic Ultrasound in Diagnosing Adnexal Torsion. ROC curve analysis revealed that the OVR demonstrated the best diagnostic accuracy at a cutoff value of 2.5 with a sensitivity of 100% and specificity of 94% (AUC 0.991, p < 0.001, Figure 2). Obstetrics and Gynecology Clinics of North America. Approximately 20% of the cases occur during pregnancy 1. Conservative management of ovarian torsion in pre-pubertal girl 3. χ2 and Fisher exact tests were used to compare the frequency of the sonographic signs by the presence or absence of laparoscopic evidence of ovarian torsion. Obstetric and Gynecologic Ultrasound: Case Review Series. It can also cause an infection (peritonitis) in the abdominal cavity. Their laparoscopic findings are presented in Table 1. It has also been suggested that malignancies and endometriomas undergo torsion less frequently because of their association with pelvic adhesions [8]. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Middle Black Sea Journal of Health Science. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. The Role of Imaging in the Evaluation of Adnexal Masses. Other common MR features included abnormal poor ovarian enhancement. Risk Factors for Strangulated Ovarian Hernia in Female Infants: the Role of Ovarian Volume. Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review. Magnetic resonance imaging performance for diagnosis of ovarian torsion in pregnant women with stimulated ovaries. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated for the sonographic signs, alone or in selected combinations. Ultrasound in 41 cases of confirmed torsion, ovarian volume of affected ovary was 12x size of normal contralateral ovary 9 CT: Common features seen on CT are enlarged ovary, uterine deviation towards torsion, smooth wall thickening of cystic mass, ascites, fallopian tube thickening 10 The medical records of the women identified were reviewed, and those who underwent diagnostic laparoscopy after the sonographic examination were included in the study group. Predictive Value of Single or Combined Ultrasound Signs in the Diagnosis of Ovarian Torsion, https://doi.org/10.7863/jum.2011.30.9.1205, Relative enlargement of ipsilateral ovary, n (%), Free fluid around ovary or in Douglas pouch, n (%), Sites of bleeding within the ovary, n (%), Relative enlargement of ipsilateral ovary, Free fluid around ovary or in Douglas pouch, Edema + abnormal flow + abnormal location, Abnormal flow + free fluid + ovarian cyst/mass, Edema + abnormal flow + enlargement + free fluid, Edema + abnormal flow + free fluid + ovarian cyst/mass, Abnormal flow + enlargement + free fluid + ovarian cyst/mass, Abnormal flow + enlargement + free fluid + abnormal location, Edema + abnormal flow + enlargement + free fluid + ovarian cyst/mass, Edema + abnormal flow + free fluid + ovarian cyst/mass + abnormal location, Edema + abnormal flow + enlargement + free fluid + ovarian cyst/mass + abnormal location, Approach (transvaginal vs transabdominal), Values reflect the results of multivariate logistic regression analysis using laparoscopic evidence of ovarian torsion as the dependent variable (. 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