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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

            • Ultrasonographic Findings

              • MR Findings

                • CT 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. Alberto EC et al: Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway. Pediatr Surg Int. 37(1):129-35, 2021
                                        2. Dawood MT et al: Adnexal torsion: review of radiologic appearances. Radiographics. 41(2):609-24, 2021
                                        3. Gounder S et al: Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond). 27(1):236-42, 2021
                                        4. Hartman SJ et al: Ovarian volume ratio is a reliable predictor of ovarian torsion in girls without an adnexal mass. J Pediatr Surg. 56(1):180-2, 2021
                                        5. Strachowski LM et al: Pearls and pitfalls in imaging of pelvic adnexal torsion: seven tips to tell it's twisted. Radiographics. 41(2):625-40, 2021
                                        6. Lipsett SC et al: Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals. J Pediatr. 231:269-72., 2020
                                        7. Otjen JP et al: Ovarian torsion: developing a machine-learned algorithm for diagnosis. Pediatr Radiol. 50(5):706-14, 2020
                                        8. Rougier E et al: Added value of MRI for the diagnosis of adnexal torsion in children and adolescents after inconclusive ultrasound examination. Diagn Interv Imaging. 101(11):747-56, 2020
                                        9. Adnexal Torsion in Adolescents: ACOG committee opinion No, 783 summary. Obstet Gynecol. 134(2):435-6, 2019
                                        10. Ayaz E et al: Evaluation of ovarian vascularity in children by using the "superb microvascular imaging" ultrasound technique in comparison with conventional doppler ultrasound techniques. J Ultrasound Med. 38(10):2751-760, 2019
                                        11. Prieto JM et al: Premenarchal patients present differently: a twist on the typical patient presenting with ovarian torsion. J Pediatr Surg. 54(12):2614-6, 2019
                                        12. Shapira-Zaltsberg G et al: Non-visualization of the ovaries on pediatric transabdominal ultrasound with a non-distended bladder: Can adnexal torsion be excluded? Pediatr Radiol. 49(10):1313-9, 2019
                                        13. Buicko JL et al: Disparities in pediatric gonadal torsion: does gender, race and insurance status affect outcomes? J Pediatr Surg. 53(7):1392-5, 2018
                                        14. Sintim-Damoa A et al: Pediatric ovarian torsion: spectrum of imaging findings. Radiographics. 37(6):1892-908, 2017
                                        15. 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
                                        16. Smorgick N et al: High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril. 105(6):1561-5, 2016
                                        17. 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
                                        18. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                        19. Oskaylı MÇ et al: Surgical approach to ovarian torsion in children. J Pediatr Adolesc Gynecol. 28(5):343-7, 2015
                                        20. 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
                                        21. 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
                                        22. Hyttel TE et al: Re-torsion of the ovaries. Acta Obstet Gynecol Scand. 94(3):236-44, 2014
                                        23. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                        24. Narayanan S et al: Fallopian tube torsion in the pediatric age group: radiologic evaluation. J Ultrasound Med. 33(9):1697-704, 2014
                                        25. 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
                                        26. 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
                                        27. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                        28. 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
                                        29. 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
                                        30. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                        31. Cheng KL et al: Ovarian torsion: appearance on MRI. Pediatr Radiol. 40 Suppl 1:S104, 2010
                                        32. Chang HC et al: Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 28(5):1355-68, 2008
                                        33. Linam LE et al: US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol. 37(10):1013-9, 2007
                                        34. Abes M et al: Oophoropexy in children with ovarian torsion. Eur J Pediatr Surg. 14(3):168-71, 2004
                                        35. Beaunoyer M et al: Asynchronous bilateral ovarian torsion. J Pediatr Surg. 39(5):746-9, 2004
                                        36. Vijayaraghavan SB: Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 23(12):1643-9; quiz 1650-1, 2004
                                        37. 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
                                        38. 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

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • CT 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. Alberto EC et al: Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway. Pediatr Surg Int. 37(1):129-35, 2021
                                                                              2. Dawood MT et al: Adnexal torsion: review of radiologic appearances. Radiographics. 41(2):609-24, 2021
                                                                              3. Gounder S et al: Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond). 27(1):236-42, 2021
                                                                              4. Hartman SJ et al: Ovarian volume ratio is a reliable predictor of ovarian torsion in girls without an adnexal mass. J Pediatr Surg. 56(1):180-2, 2021
                                                                              5. Strachowski LM et al: Pearls and pitfalls in imaging of pelvic adnexal torsion: seven tips to tell it's twisted. Radiographics. 41(2):625-40, 2021
                                                                              6. Lipsett SC et al: Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals. J Pediatr. 231:269-72., 2020
                                                                              7. Otjen JP et al: Ovarian torsion: developing a machine-learned algorithm for diagnosis. Pediatr Radiol. 50(5):706-14, 2020
                                                                              8. Rougier E et al: Added value of MRI for the diagnosis of adnexal torsion in children and adolescents after inconclusive ultrasound examination. Diagn Interv Imaging. 101(11):747-56, 2020
                                                                              9. Adnexal Torsion in Adolescents: ACOG committee opinion No, 783 summary. Obstet Gynecol. 134(2):435-6, 2019
                                                                              10. Ayaz E et al: Evaluation of ovarian vascularity in children by using the "superb microvascular imaging" ultrasound technique in comparison with conventional doppler ultrasound techniques. J Ultrasound Med. 38(10):2751-760, 2019
                                                                              11. Prieto JM et al: Premenarchal patients present differently: a twist on the typical patient presenting with ovarian torsion. J Pediatr Surg. 54(12):2614-6, 2019
                                                                              12. Shapira-Zaltsberg G et al: Non-visualization of the ovaries on pediatric transabdominal ultrasound with a non-distended bladder: Can adnexal torsion be excluded? Pediatr Radiol. 49(10):1313-9, 2019
                                                                              13. Buicko JL et al: Disparities in pediatric gonadal torsion: does gender, race and insurance status affect outcomes? J Pediatr Surg. 53(7):1392-5, 2018
                                                                              14. Sintim-Damoa A et al: Pediatric ovarian torsion: spectrum of imaging findings. Radiographics. 37(6):1892-908, 2017
                                                                              15. 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
                                                                              16. Smorgick N et al: High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril. 105(6):1561-5, 2016
                                                                              17. 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
                                                                              18. Ngo AV et al: Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 45(12):1845-55; quiz 1842-4, 2015
                                                                              19. Oskaylı MÇ et al: Surgical approach to ovarian torsion in children. J Pediatr Adolesc Gynecol. 28(5):343-7, 2015
                                                                              20. 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
                                                                              21. 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
                                                                              22. Hyttel TE et al: Re-torsion of the ovaries. Acta Obstet Gynecol Scand. 94(3):236-44, 2014
                                                                              23. Lourenco AP et al: Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 21(2):179-87, 2014
                                                                              24. Narayanan S et al: Fallopian tube torsion in the pediatric age group: radiologic evaluation. J Ultrasound Med. 33(9):1697-704, 2014
                                                                              25. 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
                                                                              26. 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
                                                                              27. Geimanaite L et al: Ovarian torsion in children: management and outcomes. J Pediatr Surg. 48(9):1946-53, 2013
                                                                              28. 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
                                                                              29. 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
                                                                              30. Wilkinson C et al: Adnexal torsion -- a multimodality imaging review. Clin Radiol. 67(5):476-83, 2012
                                                                              31. Cheng KL et al: Ovarian torsion: appearance on MRI. Pediatr Radiol. 40 Suppl 1:S104, 2010
                                                                              32. Chang HC et al: Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 28(5):1355-68, 2008
                                                                              33. Linam LE et al: US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol. 37(10):1013-9, 2007
                                                                              34. Abes M et al: Oophoropexy in children with ovarian torsion. Eur J Pediatr Surg. 14(3):168-71, 2004
                                                                              35. Beaunoyer M et al: Asynchronous bilateral ovarian torsion. J Pediatr Surg. 39(5):746-9, 2004
                                                                              36. Vijayaraghavan SB: Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 23(12):1643-9; quiz 1650-1, 2004
                                                                              37. 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
                                                                              38. Rha SE et al: CT and MR imaging features of adnexal torsion. Radiographics. 22(2):283-94, 2002