Sonographic Diagnosis of Ovarian Torsion

Abstract

In the setting of a specialized ultrasound unit, sonographic diagnosis of ovarian torsion had high (74.6%) accuracy compared with previous reports. The absence of typical sonographic signs does not rule out ovarian torsion, especially when the clinical presentation is suggestive. Basing assessments on multiple sonographic signs, including Doppler evaluation, increases the diagnostic specificity.

Core curriculum illustration: ovarian torsion

“…The most common finding on ultrasound is an asymmetrically enlarged ovary, usually with multiple peripheral follicles [1,3]. A small amount of free fluid is often visible adjacent to the torsed ovary [3]. The torsed ovary commonly does not demonstrate venous or arterial flow on color Doppler imaging; however, occasionally, a torsed ovary may continue to demonstrate arterial flow as venous flow is the first to be compromised [1,2].…”

“…The most common finding on ultrasound is an asymmetrically enlarged ovary, usually with multiple peripheral follicles [1,3]. A small amount of free fluid is often visible adjacent to the torsed ovary [3].…”

“…Ultrasound is the imaging modality of choice for ovarian torsion and has a >74 % accuracy rate [3]. The most common finding on ultrasound is an asymmetrically enlarged ovary, usually with multiple peripheral follicles [1,3].…”

Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques

“…Both arterial and venous flow are then lost in the advanced stages [70]. The ability to make a diagnosis based on ovarian vascularity has considerable variation, with a positive predictive value of 19%-94% and a negative predictive value of 46%-100% [68,69,71]. There seem to be many factors affecting accuracy: dual supply from the uterine and ovarian arteries to the ovary, incomplete or intermittent torsion, the small size of vessels and low flow in children, and the deep location of the ovary.…”

“…This limitation seems to have resulted in the claim by some authors that US is not reliable in the diagnosis or exclusion of ovarian torsion in the pediatric population [59], although other authors insist on the utility of the whirlpool sign with a transabdominal approach [77]. The US diagnosis of ovarian torsion is not straightforward, and it is affected greatly by the operator (60%- 100%) [69]. Thus, other modalities should be used in equivocal cases.…”