Presentation
Acute, severe abdominal pain, nausea, and vomiting for 1 day.
Patient Data
Markedly enlarged right ovary, which is centrally placed and located in the pelvis anterior to the uterus and fallopian tubes. It shows heterogeneous enhancement, with multiple peripheral cysts representing ovarian follicles, giving it a “string of pearl” appearance. However, no lead point is identified. The size of the ovary is approximately 5.4 x 3.4 cm.
Engorged vessels are seen along the anterosuperior aspect of the right ovary, representing a twisted pedicle pathognomic for ovarian torsion.
There is no gross deviation of the uterus to the side of the twist.
The left ovary is unremarkable. It measures 0.8 x 0.3 cm.
The uterus is of small size with respect to age, measuring 1.0 x 0.5 x 1.8 cm, representing an infantile uterus.
Mild pelvic fluid.
Case Discussion
Initially, the patient underwent an abdominal ultrasound pelvis, which revealed an enlarged oblong midline right ovary (4.9 x 3.5 cm) with peripherally displaced follicles and a small amount of fluid in the pouch of Douglas. The mild flow was noted on the color Doppler scan. The findings were immediately conveyed to the primary surgical team. Upon request from the surgical department, CECT PELVIS was performed to rule out any lead point.
Finally, the patient underwent a laparotomy, which confirmed the diagnosis. Fortunately, the torsed right ovary was salvageable. The concerned surgeons were very grateful for the timely diagnosis.
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