Ovarian torsion: Difference between revisions

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==Diagnosis==
==Diagnosis==
*[[Ultrasound]] (sensitivity 46-70%)
*[[Ultrasound]] (sensitivity 46-70%)
**Diminished or absent blood flow in the ovarian vessels
**Diminished or absent blood flow in the ovarian vessels (presence of flow does not r/o)
**Ovarian mass > 2.5-3 cm
**Ovarian mass > 2.5-3 cm
**Enlarged ovarian volume
**Enlarged ovarian volume

Revision as of 15:55, 4 November 2015

Background

  • 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
    • Account for only 50% in children (much more likely to torse normal ovaries)

Pathophysiology

  • cysts greater than 4cm more likely to torse
  • dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis
    • sonographer should document dual arterial and venous waveforms

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