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.^{[21, 22]}

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.^[23]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

Workup

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Media Gallery

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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Author

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

Disclosure: Nothing to disclose.

Coauthor(s)

Arthur C Fleischer, MD Professor, Chief of Ultrasound Imaging, Cornelius Vanderbilt Chair, Departments of Radiology 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, Society of Radiologists in Ultrasound

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, 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, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Acknowledgements

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