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Acute Adnexal Torsion
Akram M. Shaaban, MBBCh
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Ovarian torsion
                • Adnexal torsion is more accurate term, as torsion usually also includes fallopian tube
                  • Isolated fallopian tube torsion may also rarely occur
            • Definitions

              • Rotation of ovary on its vascular pedicle resulting in venous congestion and ultimately infarction of ovary

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Canning DA: Re: ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Urol. 191(1):212-3, 2014
                                        2. Erikci VS et al: Isolated salpingeal torsion in children: a case series and review of the literature. Ulus Travma Acil Cerrahi Derg. 20(1):75-8, 2014
                                        3. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                        4. Munshi S et al: Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome. J Hum Reprod Sci. 7(1):66-8, 2014
                                        5. Sasaki KJ et al: Adnexal torsion: review of the literature. J Minim Invasive Gynecol. 21(2):196-202, 2014
                                        6. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                        7. Morton MJ et al: Case report: ovarian torsion in pregnancy - diagnosis and management. J Emerg Med. 45(3):348-51, 2013
                                        8. Duigenan S et al: Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol. 198(2):W122-31, 2012
                                        9. Sibal M: Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. J Ultrasound Med. 31(11):1803-9, 2012
                                        10. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                        11. Cicchiello LA et al: Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 38(1):85-114, viii, 2011
                                        12. Mashiach R et al: Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 30(9):1205-10, 2011
                                        13. Hiei K et al: Ovarian torsion; early diagnosis by MRI to prevent irreversible damage. Clin Exp Obstet Gynecol. 37(3):233-4, 2010
                                        14. Breech LL et al: Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol. 17(5):483-9, 2005
                                        15. Cass DL: Ovarian torsion. Semin Pediatr Surg. 14(2):86-92, 2005
                                        16. Ogburn T et al: Adnexal torsion: experience at a single university center. J Reprod Med. 50(8):591-4, 2005
                                        17. White M et al: Ovarian torsion: 10-year perspective. Emerg Med Australas. 17(3):231-7, 2005
                                        18. Gittleman AM et al: Ovarian torsion: CT findings in a child. J Pediatr Surg. 39(8):1270-2, 2004
                                        19. Lambert MJ et al: Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. 22(3):683-96, 2004
                                        20. Ratani RS et al: Pediatric gynecologic ultrasound. Ultrasound Q. 20(3):127-39, 2004
                                        21. Webb EM et al: Adnexal mass with pelvic pain. Radiol Clin North Am. 42(2):329-48, 2004
                                        22. Crouch NS et al: Ovarian torsion: to pex or not to pex? Case report and review of the literature. J Pediatr Adolesc Gynecol. 16(6):381-4, 2003
                                        23. Ignacio EA et al: Ultrasound of the acute female pelvis. Ultrasound Q. 19(2):86-98; quiz 108-10, 2003
                                        24. Nishino M et al: Magnetic resonance imaging findings in gynecologic emergencies. J Comput Assist Tomogr. 27(4):564-70, 2003
                                        25. Ozcan C et al: Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion. J Pediatr Surg. 37(11):1617-20, 2002
                                        26. Promecene PA: Laparoscopy in gynecologic emergencies. Semin Laparosc Surg. 9(1):64-75, 2002
                                        27. Rha SE et al: CT and MR imaging features of adnexal torsion. Radiographics. 22(2):283-94, 2002
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Ovarian torsion
                                                      • Adnexal torsion is more accurate term, as torsion usually also includes fallopian tube
                                                        • Isolated fallopian tube torsion may also rarely occur
                                                  • Definitions

                                                    • Rotation of ovary on its vascular pedicle resulting in venous congestion and ultimately infarction of ovary

                                                  IMAGING

                                                  • General Features

                                                    • Ultrasonographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Canning DA: Re: ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Urol. 191(1):212-3, 2014
                                                                              2. Erikci VS et al: Isolated salpingeal torsion in children: a case series and review of the literature. Ulus Travma Acil Cerrahi Derg. 20(1):75-8, 2014
                                                                              3. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                                                              4. Munshi S et al: Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome. J Hum Reprod Sci. 7(1):66-8, 2014
                                                                              5. Sasaki KJ et al: Adnexal torsion: review of the literature. J Minim Invasive Gynecol. 21(2):196-202, 2014
                                                                              6. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                                                              7. Morton MJ et al: Case report: ovarian torsion in pregnancy - diagnosis and management. J Emerg Med. 45(3):348-51, 2013
                                                                              8. Duigenan S et al: Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol. 198(2):W122-31, 2012
                                                                              9. Sibal M: Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. J Ultrasound Med. 31(11):1803-9, 2012
                                                                              10. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                                                              11. Cicchiello LA et al: Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 38(1):85-114, viii, 2011
                                                                              12. Mashiach R et al: Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 30(9):1205-10, 2011
                                                                              13. Hiei K et al: Ovarian torsion; early diagnosis by MRI to prevent irreversible damage. Clin Exp Obstet Gynecol. 37(3):233-4, 2010
                                                                              14. Breech LL et al: Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol. 17(5):483-9, 2005
                                                                              15. Cass DL: Ovarian torsion. Semin Pediatr Surg. 14(2):86-92, 2005
                                                                              16. Ogburn T et al: Adnexal torsion: experience at a single university center. J Reprod Med. 50(8):591-4, 2005
                                                                              17. White M et al: Ovarian torsion: 10-year perspective. Emerg Med Australas. 17(3):231-7, 2005
                                                                              18. Gittleman AM et al: Ovarian torsion: CT findings in a child. J Pediatr Surg. 39(8):1270-2, 2004
                                                                              19. Lambert MJ et al: Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. 22(3):683-96, 2004
                                                                              20. Ratani RS et al: Pediatric gynecologic ultrasound. Ultrasound Q. 20(3):127-39, 2004
                                                                              21. Webb EM et al: Adnexal mass with pelvic pain. Radiol Clin North Am. 42(2):329-48, 2004
                                                                              22. Crouch NS et al: Ovarian torsion: to pex or not to pex? Case report and review of the literature. J Pediatr Adolesc Gynecol. 16(6):381-4, 2003
                                                                              23. Ignacio EA et al: Ultrasound of the acute female pelvis. Ultrasound Q. 19(2):86-98; quiz 108-10, 2003
                                                                              24. Nishino M et al: Magnetic resonance imaging findings in gynecologic emergencies. J Comput Assist Tomogr. 27(4):564-70, 2003
                                                                              25. Ozcan C et al: Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion. J Pediatr Surg. 37(11):1617-20, 2002
                                                                              26. Promecene PA: Laparoscopy in gynecologic emergencies. Semin Laparosc Surg. 9(1):64-75, 2002
                                                                              27. Rha SE et al: CT and MR imaging features of adnexal torsion. Radiographics. 22(2):283-94, 2002