Ovarian torsion displacing the bladder in front
- Ovarian torsion is the rotation of the ovarian vascular pedicle, which causes vascular obstruction.
- In adults, there is usually an underlying structural abnormality (dermoid cyst being the most common, in early pregnancy it’s corpus luteal cyst). However, in the pediatric population, the ovary is usually normal.
- Mean age is 10-11, with 50% of cases being in premenarchal girls.
- Symptoms: normally acute abdo pain with N&V
- Radiographic features:
US:
– enlarged hypo- or hyperechoic ovary, free fluid seen in >80% of cases
– Ovary should be tender to transducer pressure
– absence of ovarian Doppler flow is specific; but normal arterial & venous flow does not exclude dx
CT:
– Modality of choice; good at ruling out ovarian torsion if a normal ovary/adnexa is seen
– HU > 50 (hyperintense) = hemorrhagic torsion - Tx
– Most ovaries are not salvageable in which case a salpingo-oophorectomy is required. If not removed the necrotic ovary can become infected and cause abscess or peritonitis.
Reference: radiopaedia.org
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