US findings of adnexal torsion in children and adolescents: size really does matter

Abstract

An adnexal volume of <20 ml is strong evidence against adnexal torsion in menarchal females. In this age group, the diagnosis of torsion cannot be established by US examination alone.

Ovarian torsion. Management and ovarian prognosis: a report of 45 cases

“…Color Doppler sonography proposed to improve accurate diagnosis [18] has not been used in the present series. Linam et al [19] demonstrated that Doppler findings have low sensitivity and specificity for diagnosing ovarian torsion.…”

Pediatric ovarian torsion: a pictorial review

“…A study by Linam et al [19] also found that ovarian size is a good predictor of torsion. In their series, no ovarian torsion was present in ovaries that were less than 20 ml and the best predictor of torsion was a volume ratio with the normal ovary of 15 [19]. Finally, a recent case report has shown that although very uncommon, even normal ovarian volume and volume ratios can be present in patients with ovarian torsion [20].…”

“…When the median ovarian volume ratio was 20 or more, patients were 18 times more likely to have an associated underlying ovarian mass [1]. A study by Linam et al [19] also found that ovarian size is a good predictor of torsion. In their series, no ovarian torsion was present in ovaries that were less than 20 ml and the best predictor of torsion was a volume ratio with the normal ovary of 15 [19].…”

“…In post-pubertal cases, the typical lattice or retracting clot appearance could aid in identifying a hemorrhagic cyst. In atypical cases, size might be the best factor to distinguish ovarian torsion from a hemorrhagic cyst because the average diameter of a hemorrhagic cyst is 3-3.5 cm [29], while torsion is predicted by a volume ratio of 15 or more compared to the normal ovary [19].…”

Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature

“…The diagnosis of ovarian torsion relies on history, clinical findings, and supportive imaging. The most common ultrasound finding is an enlarged ovary [8]. Other findings include absence of Doppler flow, peripheral follicles of 8 to 15 mm with fluid debris levels, free intraperitoneal fluid, thickening of cyst wall, and whirlpool sign [5,[9][10][11].…”