How do you diagnose ovarian torsion?
An ultrasound (usually a transvaginal one) can confirm the diagnosis. “If a patient has severe pelvic pain and is nauseous and I can feel the cyst during a pelvic exam, we will use transvaginal ultrasound to see if the ovary is enlarged, which could indicate torsion,” Dr. Fan explains.
What are differential diagnosis of ovarian torsion?
DIFFERENTIAL DIAGNOSIS The differential diagnosis of ovarian torsion includes other conditions that present with acute pelvic pain and/or an adnexal mass and include ectopic pregnancy, ruptured ovarian cyst, tubo-ovarian abscess, and appendicitis.
What ligaments twist the ovarian torsion?
The fallopian tube often twists with the ovary and is then referred to as adnexal torsion. The ovary is supported by multiple structures in the pelvis. One ligament it is suspended by is the infundibulopelvic ligament, also called the suspensory ligament of the ovary, which connects the ovary to the pelvic sidewall.
What is the most common cause for ovarian torsion?
The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments. Another common cause is an ovarian ligament, connecting the ovary to the uterus, that is longer than usual. A longer ovarian ligament makes ovarian torsion more likely.
Can you see ovarian torsion on CT?
88% of patients with ovarian torsion [2, 10, 12]. An enlarged ovary with or without an underlying mass and a twisted pedicle, findings of torsion on ultrasound, are also seen on CT or MRI. Features that are better seen with CT or MRI include subacute ovarian hematoma and abnormal or absent ovarian enhancement.
Do you bleed with ovarian torsion?
In severe cases, if your ovary is necrotic and needs to be removed, you may have a fever. There will also be abnormal bleeding from your vagina, as well as discharge. If your abdomen or pelvic area is rigid or in pain when you stop touching your abdomen, you may already have a necrotic ovary.
What size cyst causes ovarian torsion?
Ovarian torsion occurs when an ovarian cyst or mass presents and rotates both the infundibulopelvic ligament and the UO ligament. The cyst or mass is usually a benign lesion over 5 cm in diameter [12,13,14,15].
Is ovarian torsion palpable?
The classical presentation of ovarian torsion is of abdominal pain and adnexal tenderness accompanied by a palpable mass.
What is the treatment for a twisted ovary?
Once ovarian torsion is suspected, surgery is the mainstay of diagnosis and treatment. Ovarian cystectomy, oophorectomy, or conservative treatment with detorsion can be the treatment of choice.
Why does ovarian torsion happen?
Ovarian torsion is caused by twisting of the ligaments that support the adnexa, cutting off the blood flow to the organ and represents a true surgical emergency. In order to avoid the high morbidity associated with this condition, it must be promptly diagnosed and treated.
What is the most common ultrasound finding in ovarian torsion?
Conclusion: An enlarged heterogeneous appearing ovary is the most common finding in ovarian torsion. The presence or absence of flow by Doppler sonography is not helpful in the diagnosis.
Can ultrasound rule out ovarian torsion?
The sensitivity and specificity of sonography for diagnosing ovarian torsion were determined 72.1% and 99.6%, respectively. Also, sonography had a positive predictive value (PPV) of 96.9%, a negative predictive value (NPV) of 95.9%, and a total accuracy of 96.0% for detection of ovarian torsion.
Can ovarian torsion correct itself?
Sometimes ovarian torsion resolves itself on its own, as it did with Philipps. This is called intermittent torsion, meaning that the torsed ovary twists back into place and then ceases twisting. However, experts say you shouldn’t wait to see if the ovary will twist back on its own.
Can an ultrasound detect a twisted ovary?
The sensitivity and specificity of sonography were 72.1% and 99.6%, respectively. Sonography had a positive predictive value of 96.9%, a negative predictive value of 95.9%, and a total accuracy of 96.0% for detection of ovarian torsion.
Is ovarian torsion pain constant?
When an ovary twists, women have sudden, severe pain in the pelvic area. The pain is sometimes accompanied by nausea and vomiting. Before the sudden pain, women may have intermittent, crampy pain for days or occasionally even for weeks. This pain may occur because the ovary repeatedly twists, then untwists.
Can you rule out ovarian torsion with CT?
CT can identify an underlying ovarian mass which serves as a lead point for torsion. However, not all ovaries with a mass in patients with acute pelvic pain are torted. Hence, other supportive clinical or imaging features are required to establish the diagnosis of torsion.
Can an ovarian torsion correct itself?
What are symptoms of ovarian torsion?
If your abdomen or pelvic area is rigid or in pain when you stop touching your abdomen, you may already have a necrotic ovary. Your doctor may do a pelvic exam to feel for other problems and tenderness.
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Symptoms of Ovarian Torsion
- Pelvic pain.
- Crampy pain for a few days or weeks.
- Tender abdomen.
Does ultrasound show ovarian torsion?
Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion.
How is ovarian torsion treated?
Emergency surgery is needed when a cyst has burst and bled into the abdomen or there is ovarian torsion. Cystectomy: This is the most common form of treatment. The cyst is removed without removing the ovary. Cystectomy can be done by laparoscopy or by making a larger incision in the abdomen (laparotomy).
What is ovarian torsion pain like?
Symptoms of Adnexal Torsion
When an ovary twists, women have sudden, severe pain in the pelvic area. The pain is sometimes accompanied by nausea and vomiting. Before the sudden pain, women may have intermittent, crampy pain for days or occasionally even for weeks.
What happens if ovarian torsion goes untreated?
Ovarian torsion is a gynecological emergency that occurs when there is twisting or torsion of the ovary around its ligamentous supports. If left untreated, it results in loss of blood supply to the ovary and the fallopian tube with resultant infarction and loss of function.
Will CT scan show ovarian torsion?
An enlarged ovary with or without an underlying mass and a twisted pedicle, findings of torsion on ultrasound, are also seen on CT or MRI. Features that are better seen with CT or MRI include subacute ovarian hematoma and abnormal or absent ovarian enhancement.
Who is at risk for ovarian torsion?
It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting.
Why do I need a CT scan for ovarian cyst?
CT scans do not show small ovarian tumors well, but they can see larger tumors, and may be able to see if the tumor is growing into nearby structures. A CT scan may also find enlarged lymph nodes, signs of cancer spread to liver or other organs, or signs that an ovarian tumor is affecting your kidneys or bladder.