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Journal of Ultrasound in Medicine, Vol 20, Issue 10 1083-1089, Copyright © 2001 by American Institute of Ultrasound in Medicine
Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation
F. Albayram and U. M. Hamper
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287, USA.
OBJECTIVE: To determine the spectrum of sonographic findings on gray scale
and color Doppler sonography in a series of pathologically proven cases of
ovarian and adnexal torsion. METHODS: The study population included 15
patients with surgical confirmation of ovarian or adnexal torsion, or both,
who underwent sonographic examination before surgery. All sonograms were
reviewed retrospectively. RESULTS: Gray scale abnormalities included the
following: complex masses in 11 (73%) of 15 patients, cystic masses in 3
(20%), and a solid mass in 1 (7%). Cul-de-sac fluid was present in 13 (87%)
of 15 patients. Adnexal neoplasms were present in 4 (27%) of 15 (1
granulosa cell tumor and 3 dermoid cysts) on pathologic examination.
Doppler findings were abnormal in 14 (93%) of 15 patients and normal in 1
(7%). Abnormal Doppler findings included no arterial and no venous flow in
6 (40%) of 15, decreased venous flow with no arterial flow in 5 (33%),
decreased venous flow and decreased arterial flow in 2 (13%), and decreased
arterial flow with no venous flow in 1 (7%). Small amounts of cul-de-sac
fluid were present in 13 (87%) of 15 patients. CONCLUSIONS: The diagnosis
of ovarian and adnexal torsion remains challenging. It cannot be based
solely on the absence or presence of flow on color Doppler sonography,
because the presence of arterial or venous flow does not exclude the
diagnosis of adnexal torsion. Comparison with the morphologic appearance
and flow patterns of the contralateral ovary will aid in diagnosis.
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