Difference between revisions of "Ovarian torsion"

(Pathophysiology)
(Background)
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==Background==
 
==Background==
 +
*Ovarian torsion is the rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. It is also referred to as adnexal torsion and tubo-ovarian torsion.
 
*Occurs in females of all ages (most common in reproductive age women)
 
*Occurs in females of all ages (most common in reproductive age women)
*Ovarian cysts (usually > 5 mm) and neoplasms account for 94% of cases in adults
+
*Ovarian cysts (usually > 4cm) and neoplasms account for 94% of cases in adults.<ref>Amirbekian S et al. Ultrasound Evaluation of Pelvic Pain. Radiol. Clin. North Am. 2014;52 (6): 1215-1235</ref> However in children they are only less common in children.
**Account for only 50% in children (much more likely to torse normal ovaries)
+
*In children hypermobility of the ovary many be the primary cause of torsion.
  
 
===Pathophysiology===
 
===Pathophysiology===
 +
Torsion occurs from either of the two causes:
 +
#Hypermobility of the ovary
 +
#Adnexal mass
 
*Cysts greater than 4cm more likely to torse<ref>M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282</ref>
 
*Cysts greater than 4cm more likely to torse<ref>M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282</ref>
*The ovaries have a dual ovation blood supply so  even if flow negative but significant pain still consider as diagnosis
+
*Absence of ovarian Doppler flow is highly specific for torsion, but normal Doppler flow does not completely exclude torsion
**sonographer should document dual arterial and venous waveforms
 
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 10:23, 6 November 2015

Background

  • Ovarian torsion is the rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. It is also referred to as adnexal torsion and tubo-ovarian torsion.
  • Occurs in females of all ages (most common in reproductive age women)
  • Ovarian cysts (usually > 4cm) and neoplasms account for 94% of cases in adults.[1] However in children they are only less common in children.
  • In children hypermobility of the ovary many be the primary cause of torsion.

Pathophysiology

Torsion occurs from either of the two causes:

  1. Hypermobility of the ovary
  2. Adnexal mass
  • Cysts greater than 4cm more likely to torse[2]
  • Absence of ovarian Doppler flow is highly specific for torsion, but normal Doppler flow does not completely exclude torsion

Clinical Features

  • Nausea/vomiting (70%)
  • Sudden and sharp pain in the lower abdomen (59%)
    • can be intermittent
  • Fever (<2%)

Differential Diagnosis

RLQ Pain

LLQ Pain

Diagnosis

  • Ultrasound (sensitivity 46-70%)
    • Diminished or absent blood flow in the ovarian vessels (presence of flow does not r/o)
    • Ovarian mass > 2.5-3 cm
    • Enlarged ovarian volume
    • Loss of echogenicity
    • Edema
    • Free fluid
  • CT may be used to r/o other possible causes of lower abdominal pain; also exclude presence of pelvic mass
  • Gold standard: direct visualization!

Treatment

  • Emergent OB/GYN consult in ED

See Also

References

  1. Amirbekian S et al. Ultrasound Evaluation of Pelvic Pain. Radiol. Clin. North Am. 2014;52 (6): 1215-1235
  2. M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282