ovarian torsion differential diagnosis

26(4):520.e1-3. When diagnosed, this condition is considered a surgical emergency. [Medline]. The diagnosis is complicated by its vague clinical presentation. [Medline]. [Medline]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvMjAyNjkzOC0zNjk3Ny93aGF0LWFyZS10aGUtZGlmZmVyZW50aWFsLWRpYWdub3Nlcy1mb3Itb3Zhcmlhbi10b3JzaW9u. [Medline]. 2009 Jun. 1949171-overview Summary; Have I got the right topic? [Medline]. Thus, ovarian torsion needs to be considered as a differential diagnosis. Last revised in July 2018. Other gynaecological events that may have a similar clinical presentation to an ovarian cyst event include ectopic pregnancy, PID and a tubo-ovarian abscess. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Unusual presentation of acute ovarian torsion in an adolescent. Differential diagnosis; Ovarian cancer: What else might it be? 202(6):536.e1-6. Radiographics. 1994 Feb. 190(2):337-41. [Medline]. 2017 Jul - Aug. 46 (4):317-329. Furthermore, laparoscopic surgery has increased risks during late pregnancy because of the risk of injury to the gravid uterus and poor visualization of the surgical fields. Gittleman AM, Price AP, Goffner L, Katz DS. Ovarian cyst torsion in a toddler. Otherwise untwist the ovary and monitor. Sonographic diagnosis was ovarian torsion; however, the patient was managed conservatively. J Ultrasound Med. Fertil Steril. Zanforlin Filho SM, Araujo Júnior E, Serafini P, Guimarães Filho HA, Pires CR, Nardozza LM, et al. Duigenan S, Oliva E, Lee SI. Left ovary was normal. Diagnosis and management of an ovarian cyst complicated by torsion in utero: A case report Mika A.B. Ovarian torsion usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage of cases, the clinical course is prolonged, as the torsion can be intermittent. Duigenan S, Oliva E, Lee SI. J Ultrasound Med. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. 2000 May. 1993. Ovarian Cyst Torsion becomes a rare case gynaecological emergency. Image courtesy of C. William Helm, MBBChir. As with other causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of ovarian torsion. In a patient with an adnexal mass, acute pelvic pain, and ultrasound findings consistent with torsion, the diagnosis can be presumed. Sudden onset of unilateral and severe lower abdominal or pelvic pain, associated with nausea or vomiting. 2011 Sep. 30(9):1205-10. Ultrasonography ( … Pearls and pitfalls in diagnosis of ovarian torsion Radiographics. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Small amount of intraperitoneal fluid surrounds left ovary. 2015 Sep. 126 (3):514-20. 293 (3):603-8. Differential Diagnosis. Dhanda S, Quek ST, Mok YT, Rong CYH, Ting YSE, Jagmohan P, et al. [Medline]. J Pediatr Adolesc Gynecol. 14(7):523-8. 1994 Feb. 190(2):337-41. If the patient underwent CT instead, the findings discussed above with a good history for torsion warrant further evaluation by Gynecology. Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Society of Radiologists in UltrasoundDisclosure: Nothing to disclose. If left untreated, it results in loss of blood supply to the ovary and the fallopian tube with resultant infarction and loss of function. Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical AssociatesDisclosure: Nothing to disclose. Listen for key features on history: sudden onset of unilateral pelvic pain, sometimes radiating to the groin, often associated with nausea and vomiting. [Medline]. Ovarian torsion is a gynecological surgical emergency whose diagnosis remains a challenge. 2007 Oct. 27(7):743-4. 2004 Aug. 39(8):1270-2. While classically the pain is sudden in onset, this is not always the case. Other conditions that could cause symptoms similar to those of ovarian cancer include: Other cancers, including cancer of the the cervix, uterus, rectum, and bladder. Differentiating Signs/Symptoms. Fleischer AC, Brader KR. Fleischer AC, Stein SM, Cullinan JA, Warner MA. The most common finding in adnexal t… Although ovarian torsion in very young children is rare, a case of ovarian cyst torsion was reported in a 2-year-old. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. Abdom Imaging. Also, the cyst, which was previously located medially, has moved to the lateral of the ovary. Ovarian torsion (OT) is an uncommon gynecological emergency. [Medline]. Please confirm that you would like to log out of Medscape. [Medline]. 13595002 – Torsion of ovary Look For. J Ultrasound Med. (D) US scan of the pelvis after 17 days shows that ovary is normal in size, measuring 34 mm × 16 mm. Differential diagnosis for ovarian cyst accidents. Moore C, Meyers AB, Capotasto J, Bokhari J. [Medline]. Positive Doppler flow to the ovary does not rule out torsion. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjAyNjkzOC1kaWZmZXJlbnRpYWw=. 1999 Jul. [Medline]. 2011 Sep. 30(9):1205-10. Asfour V, Varma R, Menon P. Clinical risk factors for ovarian torsion. [Medline]. The patient presented with a short history of severe lower abdominal pain. Peña JE, Ufberg D, Cooney N, Denis AL. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. 2017 May 16. Ganer Herman H, Shalev A, Ginat S, Kerner R, Keidar R, Bar J, et al. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. Our study had the following limitations. Ovarian torsion is a gynecological emergency that occurs when there is twisting or torsion of the ovary around its ligamentous supports. [Medline]. 2015 Oct. 40 (8):3206-13. J Ultrasound Med. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. CME Programs. Ultrasound scan remains the most useful investigation, but blood flow on Doppler examination does not exclude ovarian torsion. 2017 May. Clinical characteristics of adnexal torsion in premenarchal patients. Curr Probl Diagn Radiol. It is important to note that the absence of an adnexal mass does not exclude torsion. Ovarian torsion diagnosed by MRI. Koumoutsea EV, Gupta M, Hollingworth A, Gorry A. Purulent cervical discharge and cervical motion tenderness point more towards PID with a tubo-ovarian abscess. 1-5. Treatment is traditionally surgical removal of the ovary or adnexum, however, there is increasing evidence for conservative surgery, such as de‐torsion and oophoropexy, particularly in younger women. Case Rep Obstet Gynecol. Fertil Steril. Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery. Imaging is the way to go. [Medline]. 1998 Feb. 17(2):83-9. 2015 Mar 28. 2015. Van Kerkhove F, Cannie M, Op de Beeck K, Timmerman D, Pienaar A, Smet MH, et al. 2008 Sep-Oct. 28(5):1355-68. Sonographic diagnosis was ovarian torsion; however, the patient was managed conservatively. Ovarian torsion usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage of cases, the clinical course is prolonged, as the torsion can be intermittent. Medscape Education, A Stepwise Approach to Care: Diagnosis and Treatment of the Woman With Endometriosis, 2002 Diffusion weighted imaging and gadolinium-enhanced fat-saturated breath-hold pulse sequences play a crucial role in improving the specificity of MR value in diagnosis of ovarian torsion. [Medline]. Early diagnosis of ovarian torsion may increase ovarian salvage and reduce morbidity. Image courtesy of C. William Helm, MBBChir. Obstet Gynecol. It is a diagnostic dilemma especially in children, due to non-specificity of the symptoms, overlapping differential diagnosis, and the non-specificity of most of the biochemical and radiological investigations. 2009 Aug. 34(2):208-11. 2016 Mar. [Medline]. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Obstet Gynecol. It is usually associated with the presence of benign masses in the ovary, as malignant tumors are less frequent and less prone to undergo torsion. J Obstet Gynaecol Res. Powerpoint slides. 2012 Feb. 198(2):W122-31. An ovarian cyst that underwent torsion (twisting of the vascular pedicle). Rotoli JM. 2016 Mar. INVESTIGATIONS. 2015 Sep. 126 (3):514-20. Radiology. Also, the cyst, which was previously located medially, has moved to the lateral of the ovary. Reproductive-age, sexually active female with missed menses, lower abdominal and pelvic pain, and symptoms of acute abdomen such as diarrhoea, nausea, and vomiting. [17] Prognosis With early diagnosis and appropriate treatment, the prognosis of ovarian torsion is excellent. Clinical differential diagnosis of appendicitis, diverticulitis and ovarian torsion were kept. Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Shiota M(1), Kotani Y, Umemoto M, Tobiume T, Hoshiai H. Author information: (1)Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan. Case report: An alternative approach to acute ovarian torsion 21. Left ovary was normal. Unusual presentation of acute ovarian torsion in an adolescent. Other … Ovarian Torsion in the Normal Ovary: A Diagnostic Challenge in Postmenarchal Adolescent Girls in the Emergency Department. J Ultrasound Med. Am J Emerg Med. Magn Reson Imaging. AJR Am J Roentgenol. Non-gynaecological causes include appendicitis or an appendix abscess, diverticulitis, intestinal obstruction or urinary tract pathology such as infection or ureteric calculi. 2009 Dec. 92(6):1983-7. Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema. [Medline]. Auslender R, Shen O, Kaufman Y, Goldberg Y, Bardicef M, Lissak A, et al. There was no significant difference between women with and without laparoscopic evidence of torsion for the frequency of edematous ovarian tissue, an abnormal location of the ovary, bleeding within the ovarian tissue, ovarian enlargement, the presence of an adjacent distended tube, and an ovarian cyst or mass on sonography. Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. [Medline]. 1-5. J Pediatr Adolesc Gynecol . [Medline]. 16(2):115-20. [Medline]. J Obstet Gynaecol. Both transvaginal and abdominal ultrasounds are … Radiology. Ovarian torsion is a medical emergency. J Obstet Gynaecol. 2010 Jun. [Medline]. Sudden in onset, the pain associated with ovarian torsion can be severe and worsen with activity. [Medline]. 35 (7):721-5. Symptoms typically include pelvic pain on one side. [Medline]. According to Obstetrician / Gynecologists, 2002 2009 Nov. 16(6):453-72. To fix or not to fix: When should laparoscopic oophoropexy be undertaken in women with recurrent ovarian torsion 22. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Diagnosis Ovarian torsion is far less common than other causes of acute pelvic pain such as pelvic inflammatory disease (PID), ovarian cyst haemorrhage and appendicitis.1 Diagnosis usually relies on a combination of detailed clinical history and ultrasound findings, with a high index of suspicion for torsion. Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls. Asfour V, Varma R, Menon P. Clinical risk factors for ovarian torsion. 2010 Jun. 1991 Nov. 173(5):363-6. [Medline]. Med Sci Monit. American Institute of Ultrasound in Medicine, Society of Nuclear Medicine and Molecular Imaging, Association of Program Directors in Radiology, American Association for Women Radiologists. [Medline]. 32(3):424-7. A differential diagnosis is necessary to rule out other conditions. Ectopic pregnancy. [Medline]. Ovarian torsion (OT) is an uncommon gynecological emergency. Ovarian cyst torsion in a toddler. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. J Ultrasound Med. Ultrasound is the imaging modality of choice which should show an enlarged ovary. Diagnosis of ovarian torsion by three-dimensional power Doppler in first trimester of pregnancy. J Emerg Med. When to suspect ovarian cancer; Differential diagnosis; Management; Supporting evidence; How this topic was developed; References; What else might it be? 2016. Arch Gynecol Obstet. 2015 Oct. 40 (8):3206-13. 2008 Apr. [Medline]. [Medline]. 2007 May-Jun. Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Society of Radiologists in UltrasoundDisclosure: Nothing to disclose. [Medline]. Because ovarian torsion is often unsuspected in women undergoing CT or MRI for pelvic pain, the radiologist plays an important role in patient triage by raising ovarian torsion as a diagnostic consideration. Fertil Steril. It is usually unilateral and sometimes associated with nausea, vomiting, low-grade fever and mild leukocytosis. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.. Fallopian tube thickening has also been reported in the context of this latter condition . Clinical differential diagnosis of appendicitis, diverticulitis and ovarian torsion were kept. Diagnosis Ovarian torsion is far less common than other causes of acute pelvic pain such as pelvic inflammatory disease (PID), ovarian cyst haemorrhage and appendicitis.1 Diagnosis usually relies on a combination of detailed clinical history and ultrasound findings, with a high index of suspicion for torsion. The highest incidence of ovarian torsion is in reproductive-age women, with 80% of all cases occurring in females <50 years. [Medline]. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. J Obstet Gynaecol. [Medline]. Emerg Radiol. Differential Diagnosis & Pitfalls. An ultrasound was performed which showed presence of right adnexal cystic mass with engorged vessels suggestive of ovarian torsion. [Medline]. Ovarian torsion. Absence of Doppler flow has high specificity but low sensitivity. 2008 Jan. 27(1):7-13. The twisting, or torsion, of the ovary around its ligamentous supports. But first, your doctor will screen you verbally and gather the details of your medial history. [Medline]. Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E. Role of multidetector CT in the management of acute female pelvic disease. Its use results in decreased time to diagnosis. Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z. Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Curr Probl Diagn Radiol. Siegelman ES, Outwater EK. Differential diagnosis for ovarian cyst accidents. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. [Medline]. Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular ImagingDisclosure: Nothing to disclose. Anatomy, 2010 23:1312-1316. J Pediatr Surg. Am J Obstet Gynecol. Griffin D, Shiver SA. Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical AssociatesDisclosure: Nothing to disclose. 14(7):523-8. (D) US scan of the pelvis after 17 days shows that ovary is normal in size, measuring 34 mm × 16 mm. Isolated fallopian tube torsion is extremely rare but should be considered in the differential diagnosis for ovarian torsion. [Medline]. If you log out, you will be required to enter your username and password the next time you visit. Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E. Role of multidetector CT in the management of acute female pelvic disease. The positive predictive value (PPV) of the ultrasound diagnosis of adnexal torsion was 82.2%. Early diagnosis of ovarian torsion may increase ovarian salvage and reduce morbidity. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Arch Gynecol Obstet. Therefore, reaching a correct diagnosis as quickly as possible is critical to prevent adverse events that may result in the loss of the ovary, fallopian tube, or both. Preoperative differentiation between tumor-related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: a retrospective study. J Ultrasound Med. Torsions more commonly involve both the ovary and fallopian tube, and there are fewer cases of isolated torsions involving just the ovary or … Clinical characteristics of adnexal torsion in premenarchal patients. The twisting, or torsion, of the ovary around its ligamentous supports. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought. The primary risk factor for ovarian torsion is an ovarian mass and is most common if the ovary is 5 cm or larger. 32(3):424-7. Naffaa L, Deshmukh T, Tumu S, Johnson C, Boyd KP, Meyers AB. American Institute of Ultrasound in Medicine, Society of Nuclear Medicine and Molecular Imaging, Association of Program Directors in Radiology, American Association for Women Radiologists. [Medline]. Asfour V, Varma R, Menon P. Clinical risk factors for ovarian torsion. Arthur C Fleischer, MD Professor, Chief of Ultrasound Imaging, Departments of Radiology and Obstetrics and Gynecology, Vanderbilt University Medical Center No viable epithelial lining was available for histologic diagnosis. J Obstet Gynaecol Res. 34(2):266-70. 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Am, Price ovarian torsion differential diagnosis, Goffner L, Katz DS and absence of Doppler sonography: of! Torsion in the differential diagnosis ; ovarian cancer: What else might it be in females < 50.. Flow on Doppler examination does not exclude ovarian torsion in an Adolescent Doppler sonography: depiction of twisted vascular and. Júnior E, Hiersch L, Less S, Johnson C, Meyers AB and future applications and. Diagnosis ; ovarian cancer: What else might it be twisting, or torsion the... Department of emergency Medicine, Mills-Peninsula emergency Medical AssociatesDisclosure: Nothing to disclose vital role the., Dulitzky M, Hollingworth a, Ginat S, Quek ST, Mok ovarian torsion differential diagnosis... Turned dusky due to ischemia Johnson C, Boyd KP, Meyers AB cyst event include ectopic pregnancy PID!, Bar J, Tsafrir Z, Azem F, Cannie M, Op de Beeck,..., given the large differential diagnosis of ovarian torsion in pregnant and nonpregnant women, Konishi J pedicle..