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Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. The only consistent symptom cited in most studies is abdominal pain,5–7 usually localized to a lower quadrant.7. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated for the sonographic signs, alone or in selected combinations. However, heightened awareness and suspicion of this condition are needed for timely intervention. The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs. The medical records of the women identified were reviewed, and those who underwent diagnostic laparoscopy after the sonographic examination were included in the study group. Gynecologic Ultrasound Evaluation of the Nongravid Woman with Pelvic Pain. Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway. Myths in the Evaluation and Management of Ovarian Torsion. In the remainder, in whom there was no evidence of ovarian torsion on laparoscopy, the most common finding was a hemorrhagic corpus luteum. The sensitivity of the individual signs ranged from 36.2% to 85.1%, and the specificity ranged from 18.8% to 87.5%. Nevertheless, our departmental policy indicates a high index of suspicion for ovarian torsion, and almost all women who present with severe pelvic pain (which accompanies most cases of ovarian torsion) undergo laparoscopic evaluation; therefore, the false‐negative rate was expected to be low. Initially, all possible combinations of the 8 sonographic signs were evaluated. Please check your email for instructions on resetting your password. Sonography has advanced tremendously in recent years. The study included 63 women attending an ultrasound unit of a tertiary obstetrics and gynecology department in 2002 through 2008 who had suspected ovarian torsion on sonography and subsequently underwent laparoscopy. The sonographic appearance of a torsed adnexa may be solid, cystic, or complex. Association between peak estradiol levels and ovarian torsion among symptomatic patients receiving gonadotropin treatment. Ovarian torsion represents a true surgical emergency. Acute Pelvic Pain in Premenapausal Women, Children and Infants: Evidence-Based Emergency Imaging. Corpus luteum with ovarian stromal edema is associated with pelvic pain and confusion for ovarian torsion. … and you may need to create a new Wiley Online Library account. The increase in ovarian volume begins after 6 years of age (, Table). Data on the following torsion‐related sonographic parameters were obtained from the medical records in the ultrasound unit database: (1) ovarian edema, usually manifesting as hypoechoic or heterogeneous central stroma with several small peripherally located follicles; (2) ovarian enlargement relative to the contralateral unaffected ovary; (3) an ovarian cyst or mass; (4) an abnormal ovarian location, in the midline, anterior to, or above the uterus or in the Douglas pouch; (5) abnormal ovarian blood flow, defined as the lack of venous and arterial flow or detection of only arterial flow on Doppler evaluation; (6) the presence of free fluid in the Douglas pouch or around the affected ovary; (7) evidence of a distended fallopian tube; and (8) sites of bleeding within the affected ovary. Ultrasound in 41 cases of confirmed torsion, ovarian volume of affected ovary was 12x size of normal contralateral ovary 9 CT: Common features seen on CT are enlarged ovary, uterine deviation towards torsion, smooth wall thickening of cystic mass, ascites, fallopian tube thickening 10 Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques. There was considerable variation in the accuracy of the sonographic diagnosis among the operators (mean ± SD, 78.8% ± 16.0%; range, 60.0%–100%), although the differences did not reach statistical significance (odds ratio, 0.9; 95% confidence interval, 0.2–4.7; Table 4). A combination of 2 or more sonographic signs was associated with a higher specificity and PPV for ovarian torsion (up to 100% for most combinations of ≥3) but a lower sensitivity (10.6%–55.3% for combinations of ≥3) and NPV (27.6%–40.0%). The data collected at each examination were directly saved to the database, according to departmental procedures, including the uterine and ovarian size and the presence of free fluid in the Douglas pouch. Ovarian torsion is the partial or complete rotation of the ovary on the ligamentous support (infundibulopelvic ligament and the utero-ovarian ligaments) within the abdomen, often critically limiting the blood supply to the ovary. Chemical peritonitis in pregnancy: An unusual presentation and review of the literature. Table 3 shows the accuracy of the various sonographic signs for diagnosis of ovarian torsion. Comparison with the asymptomatic contralateral side is typically very helpful. Bedside Ultrasonography for Obstetric and Gynecologic Emergencies. Obstetrics & Gynecology International Journal. The cause of torsion has been suggested to be excessively elongated utero-ovarian ligament or the increased volume and weight of an adnexal mass. The rate of torsion associated with each of the combinations was calculated as the rate of torsion in the subgroup of women in whom all of the signs included in the combination were present and none of the signs not included in the combination were present. The goal of the ED physician is to diagnose torsion in a timely fashion in an attempt to preserve ovarian function and viabili… The comparison between the serum level of interleukin-6 in women with acute ovarian torsion and other causes of lower abdominal pain. Ovarian torsion is a medical emergency. Keywords:Ovarian torsion, ultrasound, CT, MRI, prepubertal girls, adnexa. The only sonographic signs that showed a statistically significant difference were abnormal ovarian blood flow and the presence of free fluid around the affected ovary or in the Douglas pouch. χ2 and Fisher exact tests were also used to compare the proportion of cases of proved torsion associated with isolated or combined sonographic signs. Adnexal torsion in pediatric and adolescent girls, Sonographic findings of ovarian torsion in children, Preoperative sonographic and clinical characteristics as predictors of ovarian torsion, The effectiveness of spectral and color Doppler in predicting ovarian torsion: a prospective study, Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation, Color Doppler sonography of adnexal torsion, Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle, Sonographic whirlpool sign in ovarian torsion. JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY. Ovarian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2.7% to 3%.1–4 It may signal either a necrotic adnexa or an unimpaired vascularly twisted ovary. Approximately 20% of the cases occur during pregnancy 1. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. Obstetric and Gynecologic Ultrasound: Case Review Series. Four women (6.3%) had no abnormal findings on laparoscopy. We also carefully read the free‐text fields provided in the database for comments regarding the uterus, each of the ovaries, the Douglas pouch, and concluding remarks. However, the presence of normal‐appearing ovaries does not rule out the diagnosis of adnexal torsion.15. All of the statistical tests were 2 tailed, and differences were considered significant at P < .05. Dopplersonographie in Geburtshilfe und Gynäkologie. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Ovulation is the part of your menstrual cycle when your ovary releases an egg. We recommend that sonographic evaluation retain its place as the first‐line imaging study for female patients with lower quadrant pain. Copyright © 2021 Elsevier B.V. or its licensors or contributors. In conclusion, the diagnosis of ovarian torsion remains a clinical and occasionally an imaging enigma. Spectrums and Outcomes of Adnexal Torsion at Different Ages. In those with ovarian torsion, the most frequent sonographic signs were ovarian edema, abnormal ovarian blood flow, relative enlargement of the affected ovary, and the presence of free fluid around the ovary or in the Douglas pouch (Table 2). Calculate the volume for other lesions that have somewhat ellipsoid shape. The diagnostic accuracy of ovarian torsion was unrelated to the side of torsion or the sonographic approach (Table 4). The clinical management of ovarian torsion: case series of 66 patients. Ovarian Torsion- The Pitfalls in Diagnosis and Review of Current Trends in Management. Ovarian torsion was identified in 47 cases (74.6%). 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. Learn more. The study retrospectively enrolled 14 incidences of surgically confirmed ovarian torsion. Seven women with laparoscopy‐proven ovarian torsion (13%) had normal ovarian blood flow on Doppler imaging; 7 (13%) had no evidence of ipsilateral ovarian enlargement; and 28 (60%) had no evidence of an ovarian cyst or mass. Learn about our remote access options, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. It happens … In the setting of a specialized ultrasound unit, sonographic diagnosis of ovarian torsion had high (74.6%) accuracy compared with previous reports. Diagnosis of Ovarian Torsion: Is It Time to Forget About Doppler?. Transvaginal sonogram showing a large edematous homogeneous circumscribed mass surrounded by free fluid. Ovarian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2.7% to 3%. Ovarian Torsion •Partial or complete rotation of the ovarian pedicle on its axis which compromises the lymphatic and venous ... More common in childhood/reproductive years with increased risk during pregnancy. According to our data, in the setting of an ultrasound unit and a team of ultrasound specialists, the sonographic diagnosis of ovarian torsion had high accuracy compared with previous reports. Ovarian cyst torsion in reproductive age group-changing trends in management 4. Purpose: The aims of this study were to identify ultrasound-based predictors of ovarian torsion in girls without an adnexal mass and establish a set of normal values for ovarian volume ratio (OVR). The Flipped Ovary Sign in Ovarian Torsion. Abnormal ovarian blood flow and the presence of free fluid were the most diagnostically accurate isolated sonographic signs (positive predictive values, 80.0% and 89.2%, respectively; negative predictive values, 46.2% and 46.2%). This study was limited by a fairly small sample size and retrospective design, in addition to the use of data obtained from various ultrasound operators. Gynecologic Etiologies of Abdominal Pain in Pregnancy. erator), on the accuracy of the diagnosis of ovarian torsion, we performed a multivariate logistic regression analysis with ovarian torsion on laparoscopy as the dependent vari-able and the ultrasound operator (5 physicians in the ul-J Ultrasound Med 2011; 30:1205–1210 1207 Mashiach et al—Sonographic Diagnosis of Ovarian Torsion Table 2. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Treatment is traditionally surgical removal of the ovary or adnexum, however, there is increasing evidence for conservative surgery, such as de‐torsion and oophoropexy, particularly in younger women. Mass lesion volume. Cases of CLOE that were misdiagnosed as torsion and cases of ovarian torsion without a lead-point mass were analyzed. 11B—13-year-old premenarchal girl with ovarian torsion. The Role of Imaging in the Evaluation of Adnexal Masses. Our main findings were as follows: (1) sonographic diagnosis of ovarian torsion had overall accuracy of 74.6%; (2) the most frequent laparoscopic finding in cases of an erroneous sonographic diagnosis of ovarian torsion was a hemorrhagic corpus luteum; (3) abnormal ovarian blood flow and free fluid were the most accurate isolated sonographic signs of ovarian torsion; (4) a substantial proportion of women had ovarian torsion despite the presence of normal ovarian blood flow, lack of ovarian enlargement, and lack of an ovarian cyst or mass on sonography; and (5) combinations of sonographic signs had higher specificity values and PPVs for ovarian torsion. 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