Ovarian torsion

Revision as of 10:18, 6 November 2015 by Ostermayer (talk | contribs) (Pathophysiology)


  • 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[1]
  • The ovaries have a 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


  • 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!


  • Emergent OB/GYN consult in ED

See Also


  1. M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282