Ovarian Torsion Clinical Presentation

  • Author: Arthur C Fleischer, MD; Chief Editor: Eugene C Lin, MD   more...
 
Updated: Sep 26, 2011
 

History

Classically, patients present with the sudden onset (commonly during exercise or other agitating movement) of severe, unilateral lower abdominal pain that worsens intermittently over many hours. A minority of patients, however, complain of mild pain that follows a more prolonged time course. The pain usually is localized over the involved side, often radiating to the back, pelvis, or thigh. Approximately 25% of patients experience bilateral lower quadrant pain. It may be described as sharp and stabbing or, less frequently, crampy.

Nausea and vomiting occur in approximately 70% of patients, mimicking a gastrointestinal source of pain and further obscuring the diagnosis.

A history of previous episodes may be elicited, possibly attributable to partial, spontaneously resolving torsion. Fever may occur as a late finding as the ovary becomes necrotic.

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Physical Examination

The physical examination, like the history, is typically nonspecific and is highly variable. A unilateral, tender adnexal mass has been reported in between 50 and 90% of patients. However, the absence of such a finding does not exclude the diagnosis. Tenderness to palpation is common; however, it is mild in approximately 30% and absent in another 30% of patients. Therefore, the absence of tenderness cannot be used to rule out torsion.

Peritoneal findings are infrequent and indicate advanced disease if present.

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Complications

Complications of ovarian torsion include the following:

  • Infection
  • Peritonitis
  • Sepsis
  • Adhesions
  • Chronic pain
  • Infertility (rare)
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Contributor Information and Disclosures
Author

Arthur C Fleischer, MD  Professor, Chief of Ultrasound Imaging, Departments of Radiology and Radiological sciences and Obstetrics and Gynecology, Vanderbilt University Medical Center

Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, and Society of Radiologists in Ultrasound

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD  Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

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, and Society of Nuclear Medicine

Disclosure: Nothing to disclose.

References

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Video depicts 2 findings: (1) enlarged hypovascular left ovary and (2) flow in healthy right ovary. Small amount of intraperitoneal fluid surrounds left ovary.
 
 
 
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