Learning objectives
To describe and illustrate the normal imaging appearance of the ovaries in pediatric patients.
To recognize the main radiological features of adnexal torsion and its mimics in pediatric patients.
To propose an algorithm for the differential diagnosis of adnexal torsion.
Background
The term adnexal torsion encompasses torsion of an ovary, a Fallopian tube, or both. It is defined as partial or total torsion of the vascular pedicle that makes up the suspensory ligaments of the ovary (utero-ovarian and infundibulopelvic ligaments). Torsion obstructs lymph flow, resulting in ingurgitation and edema that, if untreated, will increase venous and lymphatic pressure, reducing arterial flow and leading to ischemia and infarction.
[Fig 1]
The diagnosis is challenging because the clinical manifestations of adnexal torsion are nonspecific and can simulate other...
Findings and procedure details
The most common symptom is low abdominal pain, followed by nausea with or without vomiting. Less common but not infrequent symptoms and signs include referred pain in the flank, shoulder, or groin, and leukocytosis and fever.
Adnexal torsion can be classified according to its etiology as idiopathic (probably due to ligamentous laxity) or as secondary to an ovarian or extraovarian mass. In premenarche, idiopathic torsion is more common; in adolescents, torsion is often secondary to a mass. The most common ovarian masses are mature cystic...
Conclusion
Adnexal torsion is a surgical emergency that can lead to ovarian damage or infertility if it is not treated in time.
It is important to know the normal findings on transabdominal ultrasonography, the typical findings that can suggest torsion, as well as those of other entities that can mimic torsion that can benefit from conservative management.
Nevertheless, the diagnosis can be difficult, especially in patients with ovarian or paraovarian masses, in whom the highly suggestive clinical findings make surgical management prudent.
Personal information and conflict of interest
E. Vall Foraster:
Nothing to disclose
V. P. Beltrán Salazar:
Nothing to disclose
M. I. Romero Novo:
Nothing to disclose
M. J. Moreno Negrete:
Nothing to disclose
G. Dolz:
Nothing to disclose
H. Peris Alvà:
Nothing to disclose
References
Naffaa L, Deshmukh T, Tumu S, et al. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond. Current Problems in Diagnostic Radiology. 2017;46(4):317-329.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. RadioGraphics. 2008;28(5):1355–1368.
Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric Ovarian Torsion: Spectrum of Imaging Findings. Radiographics. 2017;37:1892-1908.
Strachowski LM, Choi HH, Shum DJ, Horrow MM. Pearls and Pitfalls in Imaging of Pelvic Adnexal Torsion: Seven Tips to Tell It's Twisted. Radiographics. 2021;41(2):625-640.
Brown DL,...