Ultrasound assessment of normal adnexa torsion

Abstract

Background: Adnexal torsion is a common gynecologic emergency. The evolution of torsion is unpredictable from complete spontaneous detorsion (rarely) to rapid progression and necrosis. Persistence at the stage of edema for several days is also possible. Prompt diagnosis and surgery are important, particularly in young fertile patients to preserve ovarian viability. The purpose of this study was to evaluate the ultrasound features of normal adnexa torsion. Material and methods: The study included 7 women of reproductive age (including 2 pregnant), referred for ultrasound assessment of clinically suspected adnexal torsion. Out of 7 patients, 6 underwent subsequent laparoscopy. Absence of any additional ovarian pathology was confirmed by both ultrasound and intraoperative inspection. The ultrasound description included ovarian volume, vascularization, ovarian stroma and parenchyma aspect, ‘‘whirlpool sign’’ and tubal edema. Results: Out of 7 cases, 6 were operated on and the diagnosis was confirmed, including 2 detorsions. In one case spontaneous detorsion has occurred with complete regression of edema within 1 month. Two sonographic patterns of twisted ovaries were noted: (1) unilaterally enlarged ovary with peripherally displaced follicles – noted in 4 cases, including in 2 patients with over 48 hrs after onset of symptoms, and (2) solid-appearing heterogeneous mass with echogenic and/or hypoechoic areas – noted in 3 cases. The “whirlpool sign” was present in 3 patients and tubal edema was present in 1 patient with normal adnexa torsion. Blood flow in the affected ovary was completely absent in only 3 patients. Conclusions: Ultrasound appearance of normal adnexa torsion may vary according to the duration of the condition. Recognition of different sonographic features of twisted normal adnexa may improve the diagnosis.