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Ovarian Torsion
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Adnexal torsion, twisted ovary
          • Definitions

            • Twisting of vascular pedicle of ovary, fallopian tube, or both → venous obstruction → edema → arterial compromise → ischemia → hemorrhagic infarction

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Rey-Bellet Gasser C et al: Is it ovarian torsion? A systematic literature review and evaluation of prediction signs. Pediatr Emerg Care. 32(4):256-61, 2016
                                        2. Smorgick N et al: High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril. 105(6):1561-1565, 2016
                                        3. Bronstein ME et al: A meta-analysis of B-mode ultrasound, doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 25(1):82-6, 2015
                                        4. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                        5. Oskaylı MÇ et al: Surgical approach to ovarian torsion in children. J Pediatr Adolesc Gynecol. 28(5):343-7, 2015
                                        6. Ozcan HN et al: Imaging findings of fetal-neonatal ovarian cysts complicated with ovarian torsion and autoamputation. AJR Am J Roentgenol. 205(1):185-9, 2015
                                        7. Sola R et al: National trends in the surgical treatment of ovarian torsion in children: An analysis of 2041 pediatric patients utilizing the nationwide inpatient sample. Am Surg. 81(9):844-8, 2015
                                        8. Hyttel TE et al: Re-torsion of the ovaries. Acta Obstet Gynecol Scand. ePub, 2014
                                        9. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                        10. Narayanan S et al: Fallopian tube torsion in the pediatric age group: radiologic evaluation. J Ultrasound Med. 33(9):1697-704, 2014
                                        11. Swenson DW et al: Ovarian torsion: case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Eur J Radiol. 83(4):733-8, 2014
                                        12. Appelbaum H et al: Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol. 26(3):167-70, 2013
                                        13. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                        14. Navve D et al: Medial or lateral location of the whirlpool sign in adnexal torsion: clinical importance. J Ultrasound Med. 32(9):1631-4, 2013
                                        15. Schmitt ER et al: Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 29(4):518-23; quiz 524-6, 2013
                                        16. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                        17. Cheng KL et al: Ovarian torsion: appearance on MRI. Pediatr Radiol. 40 Suppl 1:S104, 2010
                                        18. Chang HC et al: Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 28(5):1355-68, 2008
                                        19. Linam LE et al: US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol. 37(10):1013-9, 2007
                                        20. Abes M et al: Oophoropexy in children with ovarian torsion. Eur J Pediatr Surg. 14(3):168-71, 2004
                                        21. Beaunoyer M et al: Asynchronous bilateral ovarian torsion. J Pediatr Surg. 39(5):746-9, 2004
                                        22. Vijayaraghavan SB: Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 23(12):1643-9; quiz 1650-1, 2004
                                        23. Hurh PJ et al: Ultrasound of a torsed ovary: characteristic gray-scale appearance despite normal arterial and venous flow on Doppler. Pediatr Radiol. 32(8):586-8, 2002
                                        24. 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

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Adnexal torsion, twisted ovary
                                                • Definitions

                                                  • Twisting of vascular pedicle of ovary, fallopian tube, or both → venous obstruction → edema → arterial compromise → ischemia → hemorrhagic infarction

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Ultrasonographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Rey-Bellet Gasser C et al: Is it ovarian torsion? A systematic literature review and evaluation of prediction signs. Pediatr Emerg Care. 32(4):256-61, 2016
                                                                              2. Smorgick N et al: High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril. 105(6):1561-1565, 2016
                                                                              3. Bronstein ME et al: A meta-analysis of B-mode ultrasound, doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 25(1):82-6, 2015
                                                                              4. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                                                              5. Oskaylı MÇ et al: Surgical approach to ovarian torsion in children. J Pediatr Adolesc Gynecol. 28(5):343-7, 2015
                                                                              6. Ozcan HN et al: Imaging findings of fetal-neonatal ovarian cysts complicated with ovarian torsion and autoamputation. AJR Am J Roentgenol. 205(1):185-9, 2015
                                                                              7. Sola R et al: National trends in the surgical treatment of ovarian torsion in children: An analysis of 2041 pediatric patients utilizing the nationwide inpatient sample. Am Surg. 81(9):844-8, 2015
                                                                              8. Hyttel TE et al: Re-torsion of the ovaries. Acta Obstet Gynecol Scand. ePub, 2014
                                                                              9. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                                                              10. Narayanan S et al: Fallopian tube torsion in the pediatric age group: radiologic evaluation. J Ultrasound Med. 33(9):1697-704, 2014
                                                                              11. Swenson DW et al: Ovarian torsion: case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Eur J Radiol. 83(4):733-8, 2014
                                                                              12. Appelbaum H et al: Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol. 26(3):167-70, 2013
                                                                              13. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                                                              14. Navve D et al: Medial or lateral location of the whirlpool sign in adnexal torsion: clinical importance. J Ultrasound Med. 32(9):1631-4, 2013
                                                                              15. Schmitt ER et al: Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 29(4):518-23; quiz 524-6, 2013
                                                                              16. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                                                              17. Cheng KL et al: Ovarian torsion: appearance on MRI. Pediatr Radiol. 40 Suppl 1:S104, 2010
                                                                              18. Chang HC et al: Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 28(5):1355-68, 2008
                                                                              19. Linam LE et al: US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol. 37(10):1013-9, 2007
                                                                              20. Abes M et al: Oophoropexy in children with ovarian torsion. Eur J Pediatr Surg. 14(3):168-71, 2004
                                                                              21. Beaunoyer M et al: Asynchronous bilateral ovarian torsion. J Pediatr Surg. 39(5):746-9, 2004
                                                                              22. Vijayaraghavan SB: Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 23(12):1643-9; quiz 1650-1, 2004
                                                                              23. Hurh PJ et al: Ultrasound of a torsed ovary: characteristic gray-scale appearance despite normal arterial and venous flow on Doppler. Pediatr Radiol. 32(8):586-8, 2002
                                                                              24. Rha SE et al: CT and MR imaging features of adnexal torsion. Radiographics. 22(2):283-94, 2002