Ovarian torsion

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

• GI
  • Appendicitis
    • Perforated appendicitis
  • Peritonitis
  • Crohn's disease (terminal ileitis)
  • Diverticulitis (cecal, Asian patients)
  • Inguinal hernia
  • Mesenteric ischemia
  • Ischemic colitis
  • Meckel's diverticulum
  • Neutropenic enterocolitis (typhlitis)
• GU
  • Ectopic
  • Endometriosis
  • Kidney stone
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • PID
  • Pyelonephritis
• Other
  • Abdominal aortic aneurysm
  • Epiploic appendagitis
  • Mesenteric lymphadenitis
  • Herpes zoster
  • Psoas abscess
  • Testicular torsion

LLQ Pain

• Diverticulitis
• Kidney stone
• UTI
• Pyelonephritis
• Ectopic pregnancy
• Infectious colitis
• Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
• Inguinal hernia
• Mesenteric ischemia
• Epiploic appendagitis
• Mittelschmerz
• Ovarian cyst
• Ovarian torsion
• PID
• Psoas abscess
• Testicular torsion
• Appendicitis
• Abdominal aortic aneurysm
• Herpes zoster
• Endometriosis
• Colon cancer
• Irritable bowel syndrome
• Small bowel obstruction

Diagnosis

• Ultrasound (sensitivty 46-70%)
  • Diminished or absent blood flow in the ovarian vessels
  • Ovarian mass
• Gold standard: direct visualization!

Treatment

• Emergent OB/GYN consult in ED

See Also

• Abdominal pain