Libby Lovett Shadinger MD, Presenter: Nothing to Disclose

Rachel Kurian MD, Abstract Co-Author: Nothing to Disclose

Rochelle Filker Andreotti MD, Abstract Co-Author: Nothing to Disclose

To determine the most frequently demonstrated Doppler and grayscale sonographic characteristics of patients presenting with adnexal torsion.

The medical records and sonographic imaging of 39 patients with pathologically proven ovarian torsion were retrospectively reviewed. Statistical significance of clinical and sonographic findings was assessed using likelihood ratio chi-square analysis.

The average age of patients was 21.5 years. Right adnexal torsion was more common (29/39), and 22/39 cases were precipitated by a mass or cyst. 100% presented with abdominal pain. 85% reported vomiting, 56% had leukocytosis, and 18% had fever. 100% of affected ovaries or ovarian/mass complexes were enlarged. 19 patients (49%) had normal arterial flow upon Doppler interrogation, 18 (46%) had no arterial flow, and 2 patients demonstrated no measurable end-diastolic flow. 33% of patients had normal venous flow; 67% had no venous flow. In patients with pain duration of ≤ 1 day, 38% had normal arterial flow; 62% had abnormal or no arterial flow. 15% had normal venous flow; 85% had no venous flow. In patients presenting with pain for 3 or more days, 64% had normal arterial flow; 36% had abnormal or absent arterial flow. 57% had no venous flow, while 43% demonstrated normal venous flow. Differences in arterial and venous flow patterns between the premenarchal and reproductive age groups were not statistically significant. While duration of pain did not demonstrate a statistically significant relationship to the presence or absence of arterial flow, the relationship between duration of pain and absence of venous flow was significant and unexpectedly inverse.

Our data indicate that abdominal pain, vomiting, ovarian enlargement, and absent ovarian venous Doppler signal are the most frequently demonstrated clinical and sonographic indicators of ovarian torsion. However, ovarian enlargement, even in the presence of normal arterial and venous Doppler flow, is the most commonly associated sonographic finding.

Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement regardless of the presence or absence of ovarian Doppler signal.

Shadinger, L, Kurian, R, Andreotti, R, Preoperative Sonographic and Clinical Characteristics as a Predictor of Ovarian Torsion.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4428400.html