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History 10 years old female patient presented to ER with severe pelviabdominal pain, the pain was severe &not relieved by analgesics, she complained of severe vomiting as well.

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Ultrasound

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CAT scan of the abdomen &pelvis

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DDx DDX for other causes of acute abdomen such as: Appendicitis,acute Ovarian cysts Diverticular diseases PID Endometriosis Pregnancy,Ectopic Mesenteric ischemia Pregnancy,UTI Obstruction,large bowel UTI,female DDx for enlarged ovary with multiple peripheral cysts(follicles) by US: 1.Ovarian torsion. 2.polycystic ovary disease 3. Ovarian hyper stimulation syndrome (OHSS) 4. Hemorrhagic ovarian cysts 5-PID 6-Neoplasms rare(primary or secondary most commonly (lymphoma).

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Diagnosis Ovarian Torsion

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Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Torsion of a normal ovary is most common among young children, in whom developmental abnormalities such as excessively long fallopian tubes may be responsible.

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US features of ovarian torsoion: *Unilateral enlarged ovary (>4 cm)( The most constant finding in ovarian torsion ) The volume of the twisted ovary averages 2 8 times the normal size !!!. The ovarian stroma may be heterogeneous (2ry to hemorrhage and edema ) String of pearls sign(Peripherally arranged follicles) Coexistent mass within the twisted ovary Free pelvic fluid Twisted vascular pedicle *Usually located in the midline. American Journal of Roentgenology

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mymedicineworld.net Color Doppler Imaging The color Doppler low manifestations of ovarian torsion are highly variable and are based, in part, on the degree of vascular compromise. The classic color Doppler sonographic finding in ovarian torsion is the absence of arterial low. The presence of flow color Doppler imaging does not allow exclusion of torsion but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of f low in the twisted vascular pedicle may indicate that the ovary is not viable. Whirlpool Sign

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CT findings in ovarian torsion: The role of computed tomography (CT) has expanded, and it is increasingly used in evaluation of abdominal pain Common CT features of ovarian torsion include an enlarged ovary, uterine deviation to the twisted side, smooth wall thickening of the twisted adenxal cystic mass, fallopian tube thickening, peripheral cystic structures, and ascites. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary- sparing treatment.

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radswiki.net British Journal of Radiology

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MRI : radswiki

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DDx DDx for enlarged ovary with multiple peripheral cysts(follicles) by US: 1.Ovarian torsion. 2.polycystic ovary disease occurs starting from menarche till menopause the patient is usually obese & complaining of hirstusim,amenorrhea& infertility,enlarged both ovaries with prominent follicles 3.Ovarian hyper stimulation syndrome (OHSS) is a rare, potentially fatal, iatrogenic complication of ovulation stimulation for the treatment of infertility. 4.Hemorrhagic ovarian cysts are called the great imitator owing to their multiple appearances depending on the age of the hemorrhagic cysts are isoechoic its hard to DDx it from enlarged ovary only the follow up which demonstrates resolution of the cyst. 5-PID 6-Neoplasms rare(primary or secondary most commonly ( lymphoma ).

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