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Carugno J, Naem A, Ibrahim C, Ehinger N, Moore J, Garzon S, Laganà AS. Is color Doppler ultrasonography reliable in diagnosing adnexal torsion? A large cohort analysis. MINIM INVASIV THER 2022; 31:620-627. [DOI: https:/doi.org/10.1080/13645706.2021.1878376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/15/2021] [Indexed: 08/30/2023]
Affiliation(s)
- Jose Carugno
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antoine Naem
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Catrine Ibrahim
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Noah Ehinger
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jessica Moore
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
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Strachowski LM, Choi HH, Shum DJ, Horrow MM. Pearls and Pitfalls in Imaging of Pelvic Adnexal Torsion: Seven Tips to Tell It's Twisted. Radiographics 2021; 41:625-640. [PMID: 33646910 DOI: 10.1148/rg.2021200122] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pelvic adnexal torsion is a collective term referring to twisting of an ovary, fallopian tube, or paraovarian cyst on its axis with varying degrees of vascular compromise. Although it is the fifth most common gynecologic emergency, the diagnosis is challenging and often missed due to symptoms, physical examination findings, and imaging features that are nonspecific. Delay in salvage surgery may lead to ovarian or tubal loss, dysfunction, and infertility. The tips shared herein are based on the authors' observations of key clinical and imaging features of torsion, with the intent of heightening radiologists' index of suspicion and diagnostic accuracy in a clear and memorable fashion. Clinically, severe acute pain with a known adnexal mass or of severity to elicit nausea or vomiting should raise concern. At imaging, features of ovarian edema are key to the diagnosis, including asymmetric ovarian enlargement, peripheralized follicles, adjacent free fluid, and foci of stromal hemorrhage. The converse finding of symmetric nonenlarged ovaries in a normal location with any imaging modality has a high negative predictive value for torsion, obviating the need for additional imaging. The whirlpool sign (twisted vascular pedicle), abnormal ovarian location, and uterine tilting are additional key imaging manifestations. The presence of color Doppler flow or contrast enhancement only suggests that an ovary is still viable and should not be used to exclude the diagnosis of torsion. In cases of isolated tubal or paraovarian cyst torsion, the ovaries may appear normal; therefore, recognition of this entity along with appreciation of several key imaging findings may assist with this difficult diagnosis. An invited commentary by Dighe is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Lori M Strachowski
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Hailey H Choi
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Dorothy J Shum
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Mindy M Horrow
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
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Carugno J, Naem A, Ibrahim C, Ehinger N, Moore J, Garzon S, Laganà AS. Is color Doppler ultrasonography reliable in diagnosing adnexal torsion? A large cohort analysis. MINIM INVASIV THER 2021; 31:620-627. [PMID: 33555217 DOI: 10.1080/13645706.2021.1878376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Color Doppler ultrasonography (CDU) is widely used to diagnose adnexal torsion (AT). However, its validity remains questionable due to its low sensitivity. Our study aimed to evaluate the accuracy of CDU for the preoperative diagnosis of AT. MATERIAL AND METHODS The electronic medical records of patients who were taken to the operating room with the diagnosis of suspected AT were reviewed. Patients having surgically/pathologically-proven AT were compared with patients who were found to have a different pathology at the time of surgery. CDU validity was assessed using a 2 × 2 table and compared with a diagnostic model that consists of the Doppler findings, patient's age, and previous surgical history. RESULTS AT was diagnosed correctly in 74.6% of cases. Absent Doppler flow was seen in only 18.6% of cases. Although its specificity and positive predictive value were high, CDU had very low sensitivity and negative predictive value. The combined diagnostic model exceeded CDU alone in terms of diagnostic accuracy. CONCLUSIONS The use of CDU alone is not a reliable modality to exclude AT. Absent Doppler flow is a sign of ovarian necrosis. Clinical correlation between CDU findings and the patient's symptoms makes the diagnosis of AT more timely and accurate.
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Affiliation(s)
- Jose Carugno
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antoine Naem
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Catrine Ibrahim
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Noah Ehinger
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jessica Moore
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Abstract
There are various complications that can occur in the postpartum period, including pain, bleeding, and infection. These include complications related to cesarean section, postpartum hemorrhage and hematomas, bladder injury, torsion and uterine dehiscence, and rupture. It is important the radiologist is aware of these entities and the associated imaging features to help guide timely and appropriate management.
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Affiliation(s)
- Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East # 1A71, Salt Lake City, UT 84132, USA.
| | - Dorothy Shum
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, 3rd Floor Box #0628, San Francisco, CA 94143, USA
| | - Anne Kennedy
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East # 1A71, Salt Lake City, UT 84132, USA; Maternal Fetal Diagnostic Center, University of Utah, 30 North 1900 East # 1A71, Salt Lake City, UT 84132, USA
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