Presentation
Severe lower abdominal pain accompanied by nausea and vomiting. It was initially managed conservatively with painkillers. There were no other known comorbidities. Both the past medical history and family history were found to be insignificant. Upon examination, the patient was found to be vitally stable. A tender mass was palpable in the lower abdomen. The systemic examination yielded unremarkable results.
Patient Data
An enlarged right ovary in the midline with central T2 hyperintensity (yellow arrow) and T2 hyperintense follicles displaced peripherally 'string of pearls'.
A normal-appearing left ovary is identified on the left side.
The uterus is displaced to the right side.
A characteristic whirlpool of a twisted pedicle is seen.
Mild pelvic free fluid is also noted.
The right ovary shows some T1 hyperintensity with patchy post-contrast enhancement.
Case Discussion
The most common finding on cross-section imaging in ovarian torsion is an enlarged ovary (>4.0 cm). Specificity increases when it shows central afollicular stroma (due to hemorrhage and edema) and peripherally displaced follicles in the enlarged ovary.
An associated feature is the displacement of the uterus resulting from the mass effect of an enlarged ovary.
The presence of heterogeneous, minimal, or absent enhancement suggests the progression of ovarian torsion from ischemia to infarction. Nevertheless, the presence of enhancement does not rule out torsion entirely. In cases of a twisted ovary with a redundant blood supply, normal enhancement may still be observed, possibly indicating intermittent or recent-onset torsion.
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