Ovarian Torsion Clinical Presentation and Diagnosis
Yes, ovarian torsion commonly presents with tachycardia and pain in the lower right abdomen, though upper right back pain is less typical and may suggest another diagnosis or a complication of torsion. 1
Clinical Presentation of Ovarian Torsion
Cardinal Symptoms and Signs
- Acute onset of severe, unilateral lower abdominal pain (often right-sided) that may be sharp, sudden, and severe 2, 3
- Tachycardia (elevated heart rate) is a common associated finding due to pain and the body's response to potential ischemia 4, 3
- Nausea and vomiting occur in most cases, accompanying the severe pain 4, 3
- Tenderness and guarding in the affected lower quadrant on physical examination 3
Atypical Presentations
- Pain may radiate to the flank or back, though upper back pain specifically is less commonly reported with isolated ovarian torsion 4
- Some patients may present with fever, though this is more common in cases with necrosis or infection 5
- Symptoms can sometimes mimic renal colic, appendicitis, or other causes of acute abdomen 4
Diagnostic Approach
Initial Evaluation
- Pregnancy test (β-hCG) should be performed immediately to rule out ectopic pregnancy, which can present similarly 6
- Vital signs assessment with special attention to heart rate, as tachycardia is a common finding 3
- Physical examination focusing on abdominal tenderness, guarding, and presence of palpable adnexal mass 3
Imaging Studies
- Transvaginal and transabdominal ultrasound is the first-line imaging modality for suspected ovarian torsion 1
- Ultrasound findings suggestive of torsion include:
Diagnostic Accuracy of Imaging
- Ultrasound has a reported sensitivity of 83.3% for ovarian torsion 1
- Doppler findings have varying accuracy: absence of arterial flow (76% sensitivity, 99% specificity); absence of venous flow (100% sensitivity, 97% specificity) 1
- CT may show an enlarged, featureless, hypoenhancing ovary with swirling of the vascular pedicle, though specific diagnostic accuracy has not been well established 1
- MRI has 80-85% sensitivity for ovarian torsion but is typically used as a problem-solving tool when ultrasound is inconclusive 1
Important Clinical Considerations
Differential Diagnosis
- Appendicitis (especially with right-sided pain) 1
- Ruptured ovarian cyst 6
- Ectopic pregnancy (must be ruled out with pregnancy test) 6
- Pelvic inflammatory disease 1
- Renal colic 4
Critical Management Points
- Early diagnosis and prompt surgical intervention are essential to preserve ovarian function 2, 7
- Delaying surgery may lead to irreversible ovarian damage, necrosis, and potential infection 7, 3
- Laparoscopy is both diagnostic and therapeutic, allowing for detorsion and preservation of the ovary if viable 2, 7
Common Pitfalls
- Misdiagnosis as appendicitis or renal colic, especially with right-sided pain 4
- False reassurance from normal Doppler flow (up to 5% of torsed ovaries may have normal size and blood flow) 1
- Delayed diagnosis due to nonspecific symptoms or intermittent pain 4, 5
- Failure to consider ovarian torsion in patients without obvious risk factors 2
Risk Factors
- Presence of ovarian masses or cysts (most common risk factor) 2
- Ovarian hyperstimulation from fertility treatments 7
- Previous episodes of ovarian torsion 2
- Pregnancy 7
- Fimbrial cysts or hydatid cysts of Morgagni 5
Remember that ovarian torsion is a surgical emergency requiring prompt intervention to preserve ovarian function and prevent serious complications including sepsis and peritonitis 2, 3.