From the Guidelines
For a 27-year-old female with suspected ovarian torsion based on right lower quadrant pain and abnormal ultrasound results, immediate additional workup should include a complete blood count (CBC), comprehensive metabolic panel (CMP), urinalysis, pregnancy test (beta-hCG), and a pelvic MRI if available, as this approach prioritizes the diagnosis and treatment of ovarian torsion, which is a gynecological emergency requiring prompt intervention to preserve ovarian function 1.
The CBC can identify leukocytosis which often accompanies torsion, while the CMP assesses overall organ function. A urinalysis helps rule out urinary tract causes of pain, and a pregnancy test is essential to exclude ectopic pregnancy which can present similarly. While transvaginal ultrasound with color Doppler is typically the first-line imaging study (which appears to have already been performed), a pelvic MRI provides superior soft tissue resolution and can better characterize the ovarian blood flow, edema, and anatomical distortion characteristic of torsion.
Some key points to consider in the diagnosis of ovarian torsion include:
- The sensitivity and specificity of ultrasound signs of ovarian torsion, such as ovarian tissue edema, absence of intraovarian vascularity, and absence of arterial flow, which can guide the interpretation of imaging results 1.
- The importance of a combined transabdominal and transvaginal approach for pelvic US imaging, as this can improve the detection of ovarian torsion and other gynecological conditions 1.
- The potential for CT scan with contrast to be used if MRI is unavailable, although this should be considered carefully due to the radiation exposure, and the fact that CT evaluation has a sensitivity of 74% to 95% and a specificity of 80% to 90% for the diagnosis of adnexal torsion 1.
These tests should be ordered urgently as ovarian torsion represents a gynecological emergency requiring prompt diagnosis and surgical intervention to preserve ovarian function, as prolonged ischemia can lead to tissue necrosis within 8-12 hours of onset. The use of pelvic MRI, in particular, is supported by the most recent evidence, which highlights its superiority in characterizing ovarian blood flow, edema, and anatomical distortion 1.
From the Research
Diagnostic Approach for Suspected Ovarian Torsion
To diagnose ovarian torsion in a 27-year-old female with right lower quadrant pain and abnormal ultrasound results, the following lab work and imaging should be considered:
- Complete blood count (CBC) to rule out infection or other conditions
- Blood tests for electrolytes, blood urea nitrogen (BUN), and creatinine to assess overall health
- Urine pregnancy test to rule out pregnancy-related conditions
- Imaging studies, including:
Rationale for Diagnostic Approach
The diagnostic approach is based on the following evidence:
- Pelvic ultrasound with color Doppler is the diagnostic study of choice for ovarian torsion 2, 3, 4
- CT scan can be useful in evaluating for other possible causes of abdominal pain and in assessing for complications of ovarian torsion 2, 5
- Lab work, such as CBC and blood tests for electrolytes, BUN, and creatinine, can help rule out other conditions and assess overall health
- Urine pregnancy test can help rule out pregnancy-related conditions 6
Importance of Prompt Diagnosis and Treatment
Prompt diagnosis and treatment of ovarian torsion are crucial to prevent irreversible ovarian damage and preserve ovarian function 6, 4. Delayed diagnosis and treatment can lead to necrosis of the ovary and require surgical removal 6. Therefore, it is essential to consider ovarian torsion in the differential diagnosis of any female patient presenting with acute abdominal pain, particularly those with right lower quadrant pain and abnormal ultrasound results.