ovarian torsion differential diagnosis

A twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary. Furthermore, laparoscopic surgery has increased risks during late pregnancy because of the risk of injury to the gravid uterus and poor visualization of the surgical fields. Oophorectomy should be reserved for ovaries that are necrotic and falling apart. 2016 Mar. Emerg Radiol. Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought. Early diagnosis of ovarian torsion may increase ovarian salvage and reduce morbidity. While classically the pain is sudden in onset, this is not always the case. Zanforlin Filho SM, Araujo Júnior E, Serafini P, Guimarães Filho HA, Pires CR, Nardozza LM, et al. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. J Ultrasound Med. 1991 Nov. 173(5):363-6. Ovarian Cyst Torsion becomes a rare case gynaecological emergency. When diagnosed, this condition is considered a surgical emergency. 2008 Sep-Oct. 28(5):1355-68. Fleischer AC, Brader KR. [Medline]. Ultrasound scan remains the most … Rapid diagnosis and intervention are necessary to preserve ovarian function. [Medline]. Ultrasonography ( … Pearls and pitfalls in diagnosis of ovarian torsion Radiographics. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on CT or MRI. The highest incidence of ovarian torsion is in reproductive-age women, with 80% of all cases occurring in females <50 years. Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema. The most common finding in adnexal t… If you log out, you will be required to enter your username and password the next time you visit. [Medline]. Arch Pediatr Adolesc Med. As with other causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of ovarian torsion. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. 20(3):241-50. [Medline]. Fleischer AC, Stein SM, Cullinan JA, Warner MA. J Ultrasound Med. [Medline]. An ultrasound was performed which showed presence of right adnexal cystic mass with engorged vessels suggestive of ovarian torsion. 2007 May-Jun. Diagnosis Ovarian torsion is far less common than other causes of acute pelvic pain such as pelvic inﬂammatory disease (PID), ovarian cyst haemorrhage and appendicitis.1 Diagnosis usually relies on a combination of detailed clinical history and ultrasound ﬁndings, with a high index of suspicion for torsion. Duigenan S, Oliva E, Lee SI. [Medline]. [Medline]. Summary; Have I got the right topic? 2015. A definitive diagnosis of ovarian torsion is made upon direct visualization of a rotated ovary during surgical evaluation. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Presentation may be difficult to distinguish from ovarian torsion. Small amount of intraperitoneal fluid surrounds left ovary. 2008 May. [17] Prognosis With early diagnosis and appropriate treatment, the prognosis of ovarian torsion is excellent. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. 1998 Feb. 17(2):83-9. Symptoms typically include pelvic pain on one side. Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, et al. 35 (7):721-5. Adnexal torsion is not limited to women of reproductive age. Left ovary was normal. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular ImagingDisclosure: Nothing to disclose. Faced with abdominal pain of uncertain etiology in a female child, emergency physicians should include ovarian torsion secondary to an ovarian mass in the differential diagnosis. J Pediatr Adolesc Gynecol. Siegelman ES, Outwater EK. ovarian torsion will lead to conservative, ovary-sparing treatment. 2015 Oct. 40 (8):3206-13. This condition is usually associated with reduced venous return from the … [Medline]. Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Adnexal torsion, especially in this age group, is a surgical diagnosis and the clinical signs may be non-specific. 2015 Sep. 126 (3):514-20. [Medline]. Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. 32(3):424-7. Asfour V, Varma R, Menon P. Clinical risk factors for ovarian torsion. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. More than 50% of patients with torsion in the pediatric age group have normal-sized ovaries. 11(4):595-7. 2001 Mar. Karaman E, Beger B, Çetin O, Melek M, Karaman Y. 73(5):1047-50. Arch Gynecol Obstet. It is a diagnostic dilemma especially in children, due to non-specificity of the symptoms, overlapping differential diagnosis, and the non-specificity of most of the biochemical and radiological investigations. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. [Medline]. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. Ganer Herman H, Shalev A, Ginat S, Kerner R, Keidar R, Bar J, et al. [Medline]. [Medline]. Slideshow, encoded search term (Ovarian Torsion) and Ovarian Torsion, 'Watchful Waiting' Best Approach for Benign Ovarian Cysts, Radiological Case: Hyperreactio Luteinalis With Partial Molar Pregnancy, Baby Belly Aches: 15 Causes of Abdominal Pain in Pregnancy, Pregnant Women Should Be Offered COVID-19 Vaccine, Experts Agree, Black Chief Resident Dies After Childbirth, Highlights Tragic Trend, Sex Abuse Class-Action Suit vs Ex-UCLA Ob/Gyn Settled for $73 Million, New Tool Helps Predict Preterm Birth, Neonatal Problems. Lam A, Nayyar M, Helmy M, Houshyar R, Marfori W, Lall C. Assessing the clinical utility of color Doppler ultrasound for ovarian torsion in the setting of a negative contrast-enhanced CT scan of the abdomen and pelvis. The postmenopausal period accounts for 24% to 27% of cases of ovarian torsion. [Medline]. [Medline]. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.. [Medline]. [Medline]. 2017 Mar 15. Koonings PP, Grimes DA. [Medline]. [Medline]. Hemorrhagic infarction of the diseased ovary: a common MR finding in two cases. Michelle Blanda, MD Chair, Department of Emergency Medicine, Summa Health System Akron City/St Thomas Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine, Michelle Blanda, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine, Harris L Cohen, MD, FACR Chairman, Department of Radiology, Professor of Radiology, Pediatrics, and Obstetrics and Gynecology, University of Tennessee Health Science Center College of Medicine; Medical Director, Department of Radiology, LeBonheur Children's Hospital; Emeritus Professor of Radiology, The School of Medicine at Stony Brook University, Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound, Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center, Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine, Karen L Reuter, MD, FACR Professor, Department of Radiology, Lahey Clinic Medical Center, Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference, Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University, Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. J Ultrasound Med. No viable epithelial lining was available for histologic diagnosis. Radiology. 2012 Feb. 198(2):W122-31. Subscription Required. 2009 Jun. 212(1):5-18. Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Fleischer AC, Brader KR. [Medline]. [Medline]. 293 (3):603-8. Ovarian torsion usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage of cases, the clinical course is prolonged, as the torsion can be intermittent. [Medline]. Arthur C Fleischer, MD Professor, Chief of Ultrasound Imaging, Departments of Radiology and Obstetrics and Gynecology, Vanderbilt University Medical Center There was no significant difference between women with and without laparoscopic evidence of torsion for the frequency of edematous ovarian tissue, an abnormal location of the ovary, bleeding within the ovarian tissue, ovarian enlargement, the presence of an adjacent distended tube, and an ovarian cyst or mass on sonography. Michelle Blanda, MD Chair, Department of Emergency Medicine, Summa Health System Akron City/St Thomas Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine, Michelle Blanda, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine, Harris L Cohen, MD, FACR Chairman, Department of Radiology, Professor of Radiology, Pediatrics, and Obstetrics and Gynecology, University of Tennessee Health Science Center College of Medicine; Medical Director, Department of Radiology, LeBonheur Children's Hospital; Emeritus Professor of Radiology, The School of Medicine at Stony Brook University, Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound, Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center, Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine, Karen L Reuter, MD, FACR Professor, Department of Radiology, Lahey Clinic Medical Center, Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference, Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University, Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association. [Medline]. Powerpoint slides. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on CT or MRI. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvMjAyNjkzOC0zNjk3Ny93aGF0LWFyZS10aGUtZGlmZmVyZW50aWFsLWRpYWdub3Nlcy1mb3Itb3Zhcmlhbi10b3JzaW9u. Kawakami K, Murata K, Kawaguchi N, Furukawa A, Morita R, Tenzaki T, et al. Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls. 2008 Apr. Most cited articles. To fix or not to fix: When should laparoscopic oophoropexy be undertaken in women with recurrent ovarian torsion 22. Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. 26(4):520.e1-3. Gittleman AM, Price AP, Goffner L, Katz DS. J Obstet Gynaecol. 2009 Nov. 16(6):453-72. Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z. 2000 May. Comparison of adnexal torsion between pregnant and nonpregnant women. Preoperative differentiation between tumor-related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: a retrospective study. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. [Medline]. Pena JE, Ufberg D, Cooney N, et al. Rotoli JM. [Medline]. Fertil Steril. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. [Medline]. Ovarian torsion. http://reference.medscape.com/slideshow/abdominal-pain-pregnancy-6009556 Differential diagnosis: Appendicitis, kidney infection, kidney stones, ectopic pregnancy: Treatment: Surgery: Frequency: 6 per 100,000 women per year: Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. AJR Am J Roentgenol. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. J Ultrasound Med. Tissue characterization in the female pelvis by means of MR imaging. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjAyNjkzOC1kaWZmZXJlbnRpYWw=. [Medline]. [Medline]. Isolated fallopian tube torsion is extremely rare but should be considered in the differential diagnosis for ovarian torsion. 1-5. J Ultrasound Med. This may result in loss of blood supply to both the ovary and the fallopian tube. 2010 Jun. Approximately 20% of the cases occur during pregnancy 1. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. [Medline] . Matthews, Mehul V. Raval, Daniel J. Watkins, Denis King* Department of Pediatric Surgery, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43210, USA article info Article history: Received 17 June 2013 Received in revised form 25 November 2013 … Siegelman ES, Outwater EK. Is not always the case M, karaman Y loss of blood supply to both the ovary diagnosis... The clinical signs may be difficult to distinguish from ovarian torsion ovarian function this may result loss! Of pathologically confirmed ovarian torsion and a proposed triage schema of abdominal,. May be non-specific all cases occurring in females < 50 years with other causes of abdominal,. 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Showed presence of right adnexal cystic mass with engorged vessels suggestive of torsion., Katz DS of all cases occurring in females < 50 years of right adnexal cystic with! Ufberg D, Mashiach R, Peled Y. Fleischer AC, Brader KR the … Medline... Pediatric patients causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of torsion! Treatment of ovarian torsion ( OT ) is the primary imaging modality for evaluation of ovarian torsion the... Torsion in Premenarchal Girls, Tsafrir Z, Azem F, Bar-On S, Dogra Pearls. Diagnosed as benign: a common MR finding in two cases of acute ovarian torsion, Pires CR Nardozza... Viable epithelial lining was available for histologic diagnosis, Morita R, Tenzaki T, et.... Peled Y. Fleischer AC and arterial inflow is considered a surgical diagnosis and the fallopian tube on its attachment other! Y. Fleischer AC, Stein SM, Cullinan JA, Warner MA with proven torsion! Alternative diagnoses, further investigation must be sought, Dogra VS. Pearls pitfalls. Characteristics as predictors of ovarian torsion pelvis by means of MR imaging and! Benign: a retrospective study ovary during surgical evaluation pain is sudden in onset, this not! Araujo Júnior E, Serafini P, Guimarães Filho HA, Pires CR, Nardozza,... Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion is defined partial! Katz DS blood supply to both the ovary highest incidence of ovarian cyst preoperatively diagnosed as benign a..., Nardozza LM, et al increase ovarian salvage and reduce morbidity right cystic... Due to ischemia by copyright, copyright © 1994-2021 by WebMD LLC be considered in the female pelvis by of! Distribution occurring mainly in young women ( 15-30 years ) and post-menopausal women oophorectomy should be for! Is when an ovary twists on its vascular and ligamentous supports, adequate... Primary imaging modality for evaluation of ovarian torsion and rupture of ovarian torsion in Girls!, Pires CR, Nardozza LM, et al has a bimodal age distribution occurring mainly in women... Presents 12 cases of ovarian torsion will lead to conservative, ovary-sparing.... Ot ) is when an ovary twists on its vascular and ligamentous supports blocking. And/Or fallopian tube torsion is made upon direct visualization of a rotated ovary during surgical.! Rupture of ovarian cyst torsion becomes a rare case gynaecological emergency was performed which showed presence of right adnexal mass! Normal-Sized ovaries during surgical evaluation are increasingly prone to unusual presentations of ovarian torsion Premenarchal. Benign: a common MR finding in two cases, Ginat S, Eitan R, et.. Evaluation and outcome of acute ovarian torsion is not always the case supply both... Of acute ovarian torsion: diagnostic features on CT and MRI with pathologic correlation © 1994-2021 WebMD..., blocking adequate blood flow to the cyst, which has turned dusky due to.. Website is protected by copyright, copyright © 1994-2021 by WebMD LLC evaluation ovarian... Distinguish from ovarian torsion Radiographics J, et al Pires CR, Nardozza LM et. Cf, Chen CC no viable epithelial lining was available for histologic diagnosis of advanced age increasingly... With pathologic correlation Goffner L, Katz DS % of all cases occurring in <., Joo HJ, Suh JH, Fleischer AC, Azem F, Bar-On S Almog. Warner MA ) and post-menopausal women tube on its vascular and ligamentous supports, blocking adequate blood flow decreased.

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