Pearls and Pitfalls in Imaging of Pelvic Adnexal Torsion: Seven Tips to Tell It’s Twisted

The “Double Ovary” Sign

“…The whirlpool sign representing the twisted vascular pedicle, abnormal position of the ovary and decreased or absent flow on Doppler ultrasound may be seen 1,2 . Similar findings are common on CT/MRI with poor/absent enhancement suggestive of the diagnosis 1–5 …”

“…13 Previous reports have characterized findings such as hydrosalpinx or paraovarian cysts on sonography as signs which point toward IFTT, though these findings are seen in a range of diseases. 2,4,14 In the following case series, we describe a new and unique imaging sign, allowing for the preoperative diagnosis of isolated fallopian tube torsion, the "double ovary" sign. This sign is defined by the presence of two adjacent ovary-like structures in the adnexa, one which is the normal ovary and the other which is the ipsilateral twisted fallopian tube.…”

“…1,2 Similar findings are common on CT/MRI with poor/absent enhancement suggestive of the diagnosis. [1][2][3][4][5] While any mobile adnexal structure in the adnexa may twist in isolation or together, concomitant ovarian and tubal torsion has been shown to occur in up to 67% of cases and is therefore the most common type of adnexal torsion. 5,6 Therefore torsion can involve the ovary alone, fallopian tube alone or both.…”

“…5,6 Therefore torsion can involve the ovary alone, fallopian tube alone or both. 3,4 Isolated fallopian tube torsion (IFTT) is a rare subtype of adnexal torsion and primarily seen in reproductive age group women, with an estimated incidence of 1 in 1.5 million women. 7,8 The term isolated fallopian tube torsion is used when there is isolated twisting of the fallopian tube with normal ovaries.…”

Adnexal torsion: a review of diagnosis and management strategies

“…Abnormalities in venous flow can be highly predictive of adnexal torsion, occurring in all patients in one study [30]. However, normal Doppler flow should not be used to rule out torsion due to its lower sensitivity, potentially because arterial flow may be preserved early in presentation [30,31,32 ▪ ]. An interesting case report cited the use of known ovarian landmarks in patients with prior imaging records to diagnose a ’flipped ovary’ in patients presenting with acute onset abdominal pain [33].…”