Paediatric ImagingOvarian torsion
The ovary may become twisted at any age but most commonly occurs in the pre-pubertal age group. The ovary twists on its pedicle causing venous and arterial occlusion with ensuing
infarction. It is commoner on the right than the left. The presenting symptom is usually that of severe
abdominal pain.
Ultrasound demonstrates free fluid in the pelvis and a small mass of variable echogenicity (Fig.1) from transonic to echogenic. Typically small follicles persist around the periphery of the lesion. On colour flow the mass is avascular. The underlying ovary prior to torsion is usually normal but ovaries containing cysts or tumours are more likely to tort than normal ones. Differentiating ovarian torsion from appendicitis can be difficult and the confirmatory diagnosis is usually only reached at laparotomy.
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Longitudinal sonogram of the pelvis showing an echogenic torted ovary behind the bladder.
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Ovarian torsion, Fig.1 | |