Ovarian torsion


  • 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)


  • 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


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


  • Emergent OB/GYN consult in ED

See Also