E3482. A Twisted Development in the ER: Isolated Fallopian Tube Torsion
  1. Caroline Corban; Beth Israel Deaconess Medical Center
  2. Se-young Yoon; Beth Israel Deaconess Medical Center
  3. Robin Levenson; Beth Israel Deaconess Medical Center
Adnexal torsion is a gynecological emergency and seen in approximately 2-3% of females who present with acute pelvic pain. Although patients may present with severe acute pain, vomiting, and a surgical abdomen, the clinical presentation is often nonspecific, which can lead to a delay in diagnosis. Ovarian torsion with associated tubal torsion is far more common than isolated fallopian tubal torsion. Isolated fallopian tube torsion (IFTT) is rare, occurring in approximately 1:500,000-1.5 million women. Radiologist awareness of IFTT is important for appropriate imaging diagnosis and subsequent management. The ovaries tend to appear normal on imaging in IFTT, but familiarity with other key imaging findings is imperative to help make the diagnosis.

Educational Goals / Teaching Points
The objectives of this educational exhibit are to review the pathophysiology of IFTT, recognize key differentiating imaging features of IFTT, and discuss appropriate next steps in management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Important anatomic and clinical risk factors for IFTT include hydrosalpinx, ovarian or paraovarian (aka paratubal) cysts, history of PID, tubal ligation, and/or trauma. We will discuss differential imaging findings on ultrasound (US) and CT. On US, important findings include whirlpool sign, thickened, torsed tube (internal debris or convoluted echogenic mass, or dilated tube with thickened, echogenic walls), and importantly, normal appearance of the ovaries. Cross sectional imaging may demonstrate an adnexal mass, twisted appearance of FT, thickened tubal wall (with hyperemia or absence of flow in the wall), mucosal folds or septa within cystic adnexal structure (likely dilated FT), a whirlpool or beak sign, and importantly, normal appearance and location of ipsilateral ovary. Secondary signs on CT are free intrapelvic fluid, peritubular fat stranding, enhancement and thickening of the broad ligament, and regional ileus.

IFTT is a rare gynecological emergency that should be promptly recognized on imaging so that treatment is not delayed. IFTT should be highly considered when one sees a whirlpool sign or swirling in the adnexa with normal appearing ovaries. Treatment is surgical detorsion and possible salpingectomy.