Presentation
Severe pelvic pain for few hours.
Patient Data
Large pelvic cyst is seen at the lower abdomen measuring 6.8 x 10.3 x 7.3 cm in AP, SS and CC dimensions with a thin regular wall and clear fluid content. It is related to the left ovary.
Enlarged left ovary measuring 6.2 x 3.7 cm with heterogeneous texture and few parenchymal arterial and venous vascularity.
The left ovarian pedicle is thickened and shows partial twist. It shows high resistive arterial flow (biphasic with reversed diastolic component), raising the possibility of left ovarian torsion.
Mild free intraperitoneal fluid at the pelvis and in Morison pouch.
Normal size and location of right ovary measuring 1.4 x 2.5 cm.
Normal size of the uterus. No focal lesions. Normal endometrial thickness.
The patient was operated on based on the ultrasound findings and a large paraovarian cyst causing ovarian torsion was confirmed. Cystectomy and oophoropexy were performed.
Photos courtesy, Dr. Ahmed Zaki, Gynecology consultant, Saudi German Hospital al-Madinah.
Case Discussion
Paraovarian cysts can lead to ovarian torsion, an important gynecological emergency.
Abnormal ovarian blood flow parameters with the presence of pelvic free fluid and twisted thickened ovarian pedicle are highly specific signs of ovarian torsion. The presence of parenchymal blood flow is a marker for viability.
Ovarian artery Doppler waveform normally has a diastolic flow. Reversal or absence of the diastolic component of the arterial waveform is a sign of increased arterial resistance that can be seen in ovarian pedicle / parenchyma in cases of ovarian torsion.
Unable to process the form. Check for errors and try again.