Surgery
The surgical procedure included ipsilateral salpingo-oophorectomy in 27 (71%),
removal of a benign ovarian tumor with preservation of the ovary in 9 (23%),
total abdominal hysterectomy and bilateral salpingooophorectomy in one (2%),
and only adnexal
detorsion in one (2%) of the patients.
Pathology
All of ovarian torsion was unilateral,
with a slightly right-sided predominance (20:18).
The most common histologic diagnosis was mature cystic teratoma,
found in 21(55%) of the 38 patients.
Additional histologic diagnoses were benign cystadenoma in nine (23%),
simple cyst in one (2%),
cystadenofibroma in one (2%),
normal ovary in one(2%),
dysgerminoma in one (2%),
endometrioid carcinoma in one (2%) of the patients,
and histopathologic diagnoses were not identified because of complete tissue necrosis in two (5%).Necrosis of the torsed ovary was encountered at pathologic examination in 24 (63%) of the 38 cases.
Imaging findings
The torsed ovary and tumors were 4 to 14cm (mean,
10.0cm) in largest diameter.
Ovarian veins are identified 21 (96%) at CECT,
only both ovarian veins could not be reliably identified in one patient.
Heterogeneous enhancement of ovary vein was 7 on right ovarian vein and 8 on the left.
All of them,
ovarian veins were dominantly enhanced in cranial portion (mainly cranial to iliac crest level) than caudal portion (mainly caudal to iliac crest) and retrograde flow.
Full enhancement was 14 on each of the ovarian vein.
One right vein was no enhanced.
The asymmetrical presence of contrast medium was defined when HU difference between ovarian veins were over 50.
It was seen in 6 (28%) patients: affected side ovary veins were heterogeneous enhancement or no enhanced and nonaffected side were homogenous enhancement (figure1.2 and Table1).
All of the asymmetrical presence of contrast medium cases were hemorrhagic infarction.
Imaging findings below were summarized in Table2.
Details in 6 patient with enhanced asymmetrically of ovarian veins and other findings is summarized in Table3.
Fallopian tube thickening was determined if amorphous solid mass or targetlike appearance was noted around the ovarian mass.
This finding was seen in 23 (60%)of the 38 patients (figure3).
In 36 (94%) of the cases of torsed ovary had at least a partially cystic component.
And 25 (70%) of these cases wall thickening was present,
wall thickening was considered if it exceed 3mm.Wall thickest portion was measured and classified into two groups,
3 < 10mm and >10mm.The latter was mentioned to related hemorrhagic infarction.
Wall thickest portion measured 3 < 10mm and >10mm were seen in12 (48%) and 13 (52%) respectively.
11 cases of the latter (92%) were hemorrhagic infarction (figure4).
Lack of contrast enhancement was 12 (50%) of the 24 patients: both unenhanced and CECT or dynamic MRI was performed (figure4).
Hemorrhage within the torsed ovary was determined if its attenuation on unenhanced scans exceeds 50 HU at CT (figure5).
Hemorrhage also can be diagnosed with fat-suppressed T1-weighted images.
Hemorrhage within the torsed ovary was seen 17 (47%) of the 36 patients
Infiltration of pelvic fat was seen in 8 (21%) of the patients.
Ascites was seen 10 (26%).
Uterine deviation to the side of the involved ovary seen 19 (50%).