Presentation
Severe pelvic pain.
Patient Data
Enlarged right ovary prolapsed in the Douglas pouch of low signal on T1, high signal on T2 with significant enhancement seen on postcontrast sequences. It contains a large well-defined unilocular cystic lesion of homogeneous low T1 and high T2 content with no enhancement on postcontrast sequences. Another small hemorrhagic cyst of posterior location is noted eliciting a high signal on T1 and a low signal on T2 with numerous small follicles mainly of peripheral distribution. Evidence of twisted thickened vascular pedicle "Whirlpool sign" well-demonstrated on all sequences. Free intraperitoneal fluid around the cystic lesion and in the Douglas pouch.
The left ovary is moderately enlarged containing numerous follicles, the largest measuring 24 mm.
Case Discussion
The MRI features are most consistent with an ovarian torsion due to a large cyst with a hemorrhagic cystic component that was confirmed at surgery with resection of the cyst, detorsion of the vascular pedicle and preserved right ovary.
In 50-80%, ovarian torsion occurs in a patient with an adnexal mass and <50% in a patient with ovarian hypermobility.
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