E2461. Ovarian Torsion in Pediatric Patients: What Every Radiologist Should Know
Authors
Muhammad Khan;
University of Texas Health Science Center at Houston
Preeti Prasad;
Lebonheur Children's Hospital
vijetha Maller;
Lebonheur Children's Hospital
Background
Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, around its vascular pedicle, resulting in vascular compromise and subsequently ovarian infraction. It is a surgical emergency, with overall incidence of 2% - 3% in females with acute pelvic pain. The diagnosis of ovarian and adnexal torsion remains challenging because the presence on color Doppler flow does not exclude the diagnosis of adnexal torsion. Therefore, understanding the imaging appearance of ovarian torsion, which is important in preventing impaired fertility particularly in children.
Educational Goals / Teaching Points
Ovarian torsion is a surgical emergency, and its timely diagnosis and management is importance in preventing impaired fertility. Imaging has a substantial role as the clinical presentation is highly variable in children because these patients cannot always provide an adequate medical history. Radiologists should always have a high index of suspicion and be aware of various imaging findings especially on ultrasound.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ovarian torsion can occur in a normal ovary or in the presence of an ovarian cyst or mass.The imaging findings of ovarian torsion are varied, and the diagnosis is challenging. Ultrasound is the modality of choice for diagnosing ovarian torsion, with CT and MRI primarily used to clarify equivocal findings and help in anatomic localization. The important radiological findings of ovarian torsion include unilateral enlargement of ovary, peripherally displaced ovarian follicles resembling a string of pearls or nonvisualization of the follicles at all, twisted pedicle, edematous central ovarian stroma, midline location of the torsed ovary, solid adnexal mass, large cystic or multiseptated mass, cyst with fluid-debris level, cyst with retracting hematoma, calcification in the cyst wall, surrounding inflammatory changes, and free fluid in the pelvis.
Conclusion
Imaging has a critical role in the diagnosis of ovarian torsion in pediatric patients, and its timely diagnosis and management is of utmost importance in preventing impaired fertility. Ultrasound is the modality of choice for diagnosing ovarian torsion, with CT and MRI primarily used to clarify equivocal findings and help in anatomic localization.
