Preoperative Sonographic and Clinical Characteristics as Predictors of Ovarian Torsion

Abstract

Objective. The purpose of this study was to determine the most closely associated sonographic and clinical characteristics of ovarian torsion. Methods. The medical records and sonographic studies of 39 patients with pathologically proven ovarian torsion diagnosed at our institution from July 1, 2000, through December 31, 2005, were retrospectively reviewed. The volumes of the affected ovaries and ovary/mass complexes were compared with an age-appropriate standard. Statistical significance of the data was assessed by a likelihood ratio χ 2 analysis. Results. All patients (100%) had a chief symptom of abdominal pain. Thirty-three (85%) reported vomiting; 22 (56%) had leukocytosis; and 7 (18%) had a documented elevated temperature. All affected ovaries and ovary/mass complexes were enlarged. Twenty-one (54%) had arterial flow on Doppler interrogation, and 18 (46%) had no arterial flow. Thirteen (33%) had venous flow, and 26 (67%) had no venous flow. Differences in the arterial and venous flow patterns between the premenarchal and reproductive age groups were not statistically significant. Conclusions. Abdominal pain, vomiting, ovarian enlargement, and absence of ovarian venous Doppler flow are the most frequently shown clinical and sonographic indicators of ovarian torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement regardless of the presence or absence of an ovarian Doppler signal.

Preoperative Magnetic Resonance Imaging Diagnosis of Ovarian Torsion

“…Furthermore, we were unable to identify a significant difference in the frequency of acute abdominal pain when compared between patients with and without ovarian torsion (P = 1.00). Although most laboratory findings are normal in patients with ovarian torsion, some studies have identified a minor degree of leukocytosis in 27%-50% of patients (12,13). In the present study, only 20% of the patients with ovarian torsion exhibited leukocytosis, and no statistical difference was found in the frequency of leukocytosis when compared between patients with and without ovarian torsion (P = 1.00).…”

Clinico-Pathological Profile of Adnexal Torsion Cases: A Retrospective Analysis from A Tertiary Care Teaching Hospital

“…The use of Doppler ultrasound also helps in the diagnosis to a great extent. Shadinger et al, [9] in a retrospective study of 39 adnexal torsion cases found a positive predictive value of 94% for the doppler finding of absent venous flow. The sonographic findings which may predict adnexal torsion are visualisation of a cystic, solid or complex mass at the location of the adnexal, cranial to the uterine fundus, thickening of the adnexal wall, unilateral ovarian enlargement, peripherally enlarged follicles, cystic hemorrhage and free pelvic fluid.…”

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

“…Adnexal torsion is considered to be a difficult diagnosis before surgery, and the correct diagnosis is made in only less than half of the cases. 15 Because of the nonspecific signs and symptoms associated with ovarian torsion, a high index of suspicion is required when deciding whether to intervene surgically. 8 As the presenting symptoms and signs in postmenopausal women are indefinite and nonspecific, the diagnosis of adnexal torsion is not often considered.…”