Ovarian Torsion Differential Diagnoses

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

Diagnostic Considerations

Confident and early diagnosis of ovarian torsion (adnexal torsion) is imperative. Color Doppler ultrasonography has a vital role in the examination of women with lower abdominal and pelvic pain.[6, 7]

Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy.

Adnexal torsion is not limited to women of reproductive age.[8] Ovarian tumors, both benign and malignant, are common in postmenopausal women and may result in torsion. As with other causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of ovarian torsion.

More than 50% of patients with torsion in the pediatric age group have normal-sized ovaries. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought.

In addition to the conditions listed in the differentials, problems to be considered include the following:

  • Ovarian tumor
  • Tubal ovarian abscess
  • Ureteral calculi
  • Perforated colonic carcinoma

Differential Diagnoses

Proceed to Workup
 
 
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

  1. Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet. Nov 1991;173(5):363-6. [Medline].

  2. Griffin D, Shiver SA. Unusual presentation of acute ovarian torsion in an adolescent. Am J Emerg Med. May 2008;26(4):520.e1-3. [Medline].

  3. Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. Ovarian cyst torsion in a toddler. Am J Emerg Med. Jun 2009;27(5):632.e1-3. [Medline].

  4. Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med. Jun 2005;159(6):532-5. [Medline].

  5. Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. Jun 2010;202(6):536.e1-6. [Medline].

  6. Fleischer AC, Brader KR. Sonographic depiction of ovarian vascularity and flow: current improvements and future applications. J Ultrasound Med. Mar 2001;20(3):241-50. [Medline].

  7. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med. Feb 1998;17(2):83-9. [Medline].

  8. Koonings PP, Grimes DA. Adnexal torsion in postmenopausal women. Obstet Gynecol. Jan 1989;73(1):11-2. [Medline].

  9. Fleischer AC, Stein SM, Cullinan JA, Warner MA. Color Doppler sonography of adnexal torsion. J Ultrasound Med. Jul 1995;14(7):523-8. [Medline].

  10. Peña JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril. May 2000;73(5):1047-50. [Medline].

  11. Zanforlin Filho SM, Araujo Júnior E, Serafini P, Guimarães Filho HA, Pires CR, Nardozza LM, et al. Diagnosis of ovarian torsion by three-dimensional power Doppler in first trimester of pregnancy. J Obstet Gynaecol Res. Apr 2008;34(2):266-70. [Medline].

  12. Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J. Ovarian torsion: CT and MR imaging appearances. Radiology. Feb 1994;190(2):337-41. [Medline].

  13. Siegelman ES, Outwater EK. Tissue characterization in the female pelvis by means of MR imaging. Radiology. Jul 1999;212(1):5-18. [Medline].

  14. Van Kerkhove F, Cannie M, Op de Beeck K, Timmerman D, Pienaar A, Smet MH, et al. Ovarian torsion in a premenarcheal girl: MRI findings. Abdom Imaging. May-Jun 2007;32(3):424-7. [Medline].

  15. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. Sep-Oct 2008;28(5):1355-68. [Medline].

  16. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril. Dec 2009;92(6):1983-7. [Medline].

  17. Auslender R, Shen O, Kaufman Y, Goldberg Y, Bardicef M, Lissak A, et al. Doppler and gray-scale sonographic classification of adnexal torsion. Ultrasound Obstet Gynecol. Aug 2009;34(2):208-11. [Medline].

  18. Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med. Jan 2008;27(1):7-13. [Medline].

  19. Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. Sep 2011;30(9):1205-10. [Medline].

  20. Gittleman AM, Price AP, Goffner L, Katz DS. Ovarian torsion: CT findings in a child. J Pediatr Surg. Aug 2004;39(8):1270-2. [Medline].

  21. Moore C, Meyers AB, Capotasto J, Bokhari J. Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema. Emerg Radiol. Mar 2009;16(2):115-20. [Medline].

  22. Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E. Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol. Nov 2009;16(6):453-72. [Medline].

  23. Kawakami K, Murata K, Kawaguchi N, Furukawa A, Morita R, Tenzaki T, et al. Hemorrhagic infarction of the diseased ovary: a common MR finding in two cases. Magn Reson Imaging. 1993;11(4):595-7. [Medline].

  24. MacDuff R, Anthony GS, MacLennan AC. Ovarian torsion diagnosed by MRI. J Obstet Gynaecol. Oct 2007;27(7):743-4. [Medline].

 
Previous
Next
 
Video depicts 2 findings: (1) enlarged hypovascular left ovary and (2) flow in healthy right ovary. Small amount of intraperitoneal fluid surrounds left ovary.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.