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Adnexal Torsion

New Clinical and Imaging Observations by Sonography, Computed Tomography, and Magnetic Resonance Imaging

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA. Dr Chiou is currently with the Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan.

Address correspondence to Anna S. Lev-Toaff, MD, Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Suite 763L, Main Building, Philadelphia, PA 19107 USA. E-mail: anna.lev-toaff{at}jefferson.edu

Objective. The purpose of this study was to review the clinical, imaging, and pathologic findings associated with adnexal torsion. Methods. A review of surgically proven cases of torsion between 1990 and 2006 included clinical, surgical, and pathologic data and preoperative sonographic, computed tomographic (CT), and magnetic resonance imaging (MRI) studies. Imaging reports were assessed to determine whether a correct preoperative diagnosis was made. Factors related to failure to make a correct diagnosis were evaluated. Results. Fifty-eight cases of torsion were evaluated (patient ages, 12–85 years; 14 postmenopausal). There was a slight right-sided predominance (55%); in most cases (72%), both the ovary and fallopian tube were involved. Common symptoms/signs were pain (91%), leukocytosis (64%), nausea/vomiting (62%), and a palpable mass (41%). Twenty-eight patients (48%) had previous abdominal surgery; in 12 (46%) of these 28, pelvic adhesions were noted. At pathologic examination, underlying adnexal masses were found in 30 cases (52%); they were benign in 26 (87%) of 30 cases. Common imaging findings were an adnexal mass (65% on sonography, 87% on CT, and 75% on MRI), a displaced adnexal mass/enlarged ovary (53% on sonography, 87% on CT, and 75% on MRI), and ascites (53% on sonography, 73% on CT, and 50% on MRI). A correct preoperative diagnosis was made by initial sonography in 15 (71%) of 21 cases versus initial CT in 5 (38%) of 13. A correct imaging diagnosis was made more frequently in premenopausal than in menopausal patients (P = .02) and in patients without an underlying adnexal mass compared with those with a mass (P = .05). Conclusions. Although CT shows features suggestive of torsion, in our study, the diagnostic value of initial CT was less than that of initial sonography. A correct preoperative diagnosis was made less often with an underlying adnexal mass and in postmenopausal women. Previous surgery and adhesions may be predisposing factors for adnexal torsion.

Key Words: adnexal torsion • computed tomography • fallopian tube • ovary • sonography

Abbreviations: CT, computed tomographic • MRI, magnetic resonance imaging • OHSS, ovarian hyperstimulation syndrome

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