From the Guidelines
Ovarian torsion typically presents with severe pelvic pain, often accompanied by nausea, vomiting, and abdominal tenderness.
Symptoms of Ovarian Torsion
- Severe pelvic pain
- Nausea and vomiting
- Abdominal tenderness
- Adnexal tenderness is a common finding, with a unilaterally enlarged ovary and central afollicular stroma, and multiple uniform peripheral follicles [ 1 ]
Diagnostic Imaging
- Transvaginal ultrasound (TVUS) is the most useful imaging modality for initial assessment, with a sensitivity of 83.3% for ovarian torsion [ 1 ]
- Absence of intraovarian vascularity and absence of arterial flow are highly suggestive of ovarian torsion, with a sensitivity of 52% and 76%, respectively [ 1 ]
- CT abdomen and pelvis with IV contrast may also be used, with a sensitivity of 74% to 95% and a specificity of 80% to 90% for the diagnosis of adnexal torsion [ 1 ]
Key Findings
- Whirlpool sign on US, located either lateral or medial to the affected ovary, is highly suggestive of adnexal torsion [ 1 ]
- Absent or abnormal ovarian venous flow is a key finding in ovarian torsion, with a sensitivity of 100% in a prospective study of 159 patients [ 1 ]
From the Research
Symptoms of Ovarian Torsion
The symptoms of ovarian torsion can be non-specific and may mimic other disorders, making diagnosis challenging 2, 3. The most common symptoms include:
- Acute onset of pelvic pain
- Nausea and vomiting 2
- Patients may have symptoms for several hours or days 3
Diagnosis and Imaging
Imaging studies play a crucial role in making an accurate and timely diagnosis of ovarian torsion 4, 5, 6. The primary imaging modalities used include:
- Ultrasonography (US) with color Doppler
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT) Normal arterial blood flow on ultrasound does not rule out ovarian torsion, and not every patient will have a mass on imaging or a palpable mass on examination 3.
Key Findings
Key findings on imaging studies may include: