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Arkoudis NA, Efthymiou E, Koutserimpas C, Spiliopoulos S. Classics in abdominal imaging: the "whirlpool" sign of ovarian torsion on MRI. Abdom Radiol (NY) 2024; 49:678-680. [PMID: 38103061 DOI: 10.1007/s00261-023-04144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evgenia Efthymiou
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
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2
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Franco PN, García-Baizán A, Aymerich M, Maino C, Frade-Santos S, Ippolito D, Otero-García M. Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings. Life (Basel) 2023; 13:2025. [PMID: 37895407 PMCID: PMC10608316 DOI: 10.3390/life13102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.
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Affiliation(s)
- Paolo Niccolò Franco
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Alejandra García-Baizán
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - María Aymerich
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - Cesare Maino
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Sofia Frade-Santos
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, Italy
| | - Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
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3
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Thanasa E, Thanasa A, Xydias EM, Ziogas AC, Kamaretsos E, Paraoulakis I, Grapsidi V, Gerokostas EE, Kontogeorgis G, Thanasas I. Adnexal Torsion of a Mature Cystic Ovarian Teratoma With Hemorrhagic Infarction Misdiagnosed As Pelvic Inflammatory Disease in a Perimenopausal Patient: A Case Report. Cureus 2023; 15:e38680. [PMID: 37288200 PMCID: PMC10243380 DOI: 10.7759/cureus.38680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/09/2023] Open
Abstract
Mature cystic teratomas are common benign ovarian tumors. They usually occur in young women, less than 40 years old. Our case report concerns a patient of perimenopausal age who came to the hospital complaining about mild abdominal pain, fever below 37.8°C, and diarrhea. The patient had an intrauterine contraceptive device inserted. Based on the clinical findings and imaging, a possible diagnosis of pelvic inflammatory disease was set, and intravenous administration of broad-spectrum antibiotics started immediately. The decision for performing laparotomy was taken after the fact that the clinical condition and blood tests of the patient had shown no improvement. Intraoperatively, the presence of a large twisted ovarian mass with signs of total necrosis due to adnexal torsion was detected. A histological examination of the surgical specimen confirmed the diagnosis of mature cystic teratoma in the right ovary. The postoperative course was uneventful. The presentation of the case follows a brief literature review of this rare medical condition regarding the diagnostic and therapeutic approach of these patients.
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Affiliation(s)
- Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Emmanouil M Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa, GRC
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | | | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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4
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Shwyiat R, Taso OA, Al-Edwan F, Khreisat B, Al-Dubees A. Retrospective analysis of patients with surgically proven ovarian torsion, our experience. J Family Med Prim Care 2023; 12:637-643. [PMID: 37312776 PMCID: PMC10259567 DOI: 10.4103/jfmpc.jfmpc_1450_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 06/15/2023] Open
Abstract
Aim To study the patients who were admitted to our hospital with surgically proven ovarian torsion and were operated for the same and to study for whom detorsion was done. Materials and Methods A retrospective analysis of the medical records and surgical notes of 150 patients with surgically proven ovarian torsion over a 10-year period between January 2011 and January 2021 was carried out. Surgical notes included details like mode of the surgery (laparotomy or laparoscopy), type of surgery (oophorectomy, detorsion, detorsion with cystectomy), whether fixation was done or not, size of mass/ovary, laterality, appearance of the torted ovary, color of the ovary, and number of twists. Histopathologic reports of the patients who underwent oophorectomy or detorsion with cystectomy were also recorded. Results During the 10-year study period, 88 (58.7%) patients had undergone laparotomy and 62 (41.2%) patients had undergone laparoscopy. Detorsion with cystectomy was done in 96 (64%) cases, detorsion alone in 14 (9.3%) cases, and oophorectomy was done in 40 (26.6%) cases. There was no significant difference in terms of increase in postoperative complications. Conclusion Laparoscopic detorsion with cystectomy is the most common surgical procedure used for ovarian torsion at King Hussein Medical Center.
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Affiliation(s)
- Rami Shwyiat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Omar A. Taso
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Fatima Al-Edwan
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Basel Khreisat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Ammal Al-Dubees
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
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Renganathan R, Subramaniam P, Deebika S, Arunachalam VK, Shanmugam J, Cherian M. Scoring system for predicting ovarian necrosis in adnexal torsion using an ultra-short optimized MRI protocol. Abdom Radiol (NY) 2023; 48:2122-2130. [PMID: 36988699 DOI: 10.1007/s00261-023-03886-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To evaluate a MRI scoring system predicting haemorrhagic necrosis in adnexal torsion with intraoperative and/or histopathological correlation using an abbreviated and optimized MRI protocol. METHODS This retrospective observational study includes patients with adnexal torsion who underwent Magnetic Resonance Imaging(MRI) and surgery. T2 sequences were evaluated by three observers of varying experience for following findings: Hypo-intensity of ovarian stroma, around the follicle, cyst wall or ovarian capsule and the twisted pedicle. Hypo-intensities in the above and a thick cyst wall were considered as predictors of necrosis. A scoring system was created based on the number of positive findings. MRI was correlated with intraoperative and histopathological findings. Lesions showing haemorrhagic necrosis were considered true positives. RESULTS 43 women with torsion were included. 74.4% were secondary to a lead point and 25.4% were without one. Hypointensity score of 2 or more had the highest diagnostic accuracy and inter-reader agreement in predicting necrosis (R1-sensitivity: 92%, specificity: 89%, positive predictive value (PPV): 92% and negative predictive value (NPV): 89%, R2-sensitivity: 92%, specificity: 94%, PPV: 96% and NPV: 90% and R3-sensitivity: 92%, specificity: 83%, PPV: 89% and NPV: 89%). CONCLUSION In patients with suspected adnexal torsion, optimized MRI using T2 weighted sequences will serve as a rapid and effective single imaging modality for diagnosing adnexal torsion and accurately predicting necrosis thereby triaging the patients for appropriate management.
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Affiliation(s)
- Rupa Renganathan
- Division of Breast and Women's Imaging, Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, 641014, India.
| | - Prema Subramaniam
- Division of Breast and Women's Imaging, Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, 641014, India
| | - S Deebika
- Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, 641014, India
| | - Venkatesh Kasi Arunachalam
- Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, 641014, India
| | - Jeevithan Shanmugam
- Department of Preventive and Social Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, 641014, India
| | - Mathew Cherian
- Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, 641014, India
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Juliette COUTUREAU, Caroline MANDOUL, Fernanda CURROSDOYON, Ingrid MILLET, Patrice TAOUREL. Recognizing the features of Isolated Fallopian Tube Torsion on CT and MRI and interobserver agreement: a cross-sectional study. Eur J Radiol 2022; 157:110607. [DOI: 10.1016/j.ejrad.2022.110607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
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7
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Jo JY, Cho IA, Shin JK, Lee SA, Choi WJ. Laparoscopic surgery for fallopian tube torsion due to benign tumour in the third trimester of pregnancy: a case report and literature review. J OBSTET GYNAECOL 2022; 42:2566-2572. [PMID: 35929982 DOI: 10.1080/01443615.2022.2107421] [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: 01/06/2023]
Abstract
Isolated fallopian tubal torsion is rare among women of reproductive age, and it is even rarer during pregnancy. Despite its rare incidence, it is important to consider this diagnosis to facilitate prompt and effective intervention. We present the case of a pregnant woman in her third trimester who presented with acute right abdominal pain. A 32-year-old primigravida woman at 29 weeks and four days of gestation visited the emergency department with acute right flank and abdominal pain. Sonography and MRI revealed the presence of a right adnexal cystic mass. Exploratory laparoscopy revealed isolated right tubal torsion and a normal ovary. To avoid torsion recurrence, we performed laparoscopic right salpingectomy. The remainder of her gestation was uneventful. Histopathological examination revealed serous cystadenoma with haemorrhagic infarction. We reviewed the literature for cases of isolated tubal torsion in the past 11 years. Twenty-three case reports were included in this study, and the average time from presentation to surgical intervention was 35.6 hours. In these cases, most of the patients underwent laparotomy and had good pregnancy outcomes. Although the approach may vary depending on the situation, the laparoscopic approach should be preferred to laparotomy in the third trimester of pregnancy.
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Affiliation(s)
- Jae Yoon Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Jeong Kyu Shin
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Soon Ae Lee
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Won Jun Choi
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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8
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Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med 2022; 14:335-345. [PMID: 35899220 PMCID: PMC9309319 DOI: 10.2147/oaem.s342724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria® which outlines imaging options based on location of pain.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
| | - Maglin Halsey-Nichols
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Ritter
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, New Orleans, LA, USA
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9
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Ovarian torsion in the pediatric population: predictive factors for ovarian-sparing surgery-an international retrospective multicenter study and a systematic review. Arch Gynecol Obstet 2022; 308:1-12. [PMID: 35751675 DOI: 10.1007/s00404-022-06522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Abstract
STUDY OBJECTIVE Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making. DESIGN We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020). PARTICIPANTS Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions. RESULTS Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary. CONCLUSIONS Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery.
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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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Characteristics and Risk Factors for Ischemic Ovary Torsion in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020206. [PMID: 35204926 PMCID: PMC8869959 DOI: 10.3390/children9020206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023]
Abstract
Identifying ischemic ovary as a complication of ovary torsion (OT) is a significant challenge in children. This study identified risk factors for ischemic OT among pediatric OT patients to prevent delayed treatment. This retrospective study included pediatric inpatients who underwent operation for OT over 20 years. We employed multivariable logistic regression to find the risk factors associated with ischemic OT. Among the 118 patients included in this study, 78 (66.1%) had ischemic OT. Patients with ischemic OT tended to be younger; had more frequent vomiting; and had elevated White blood cell (WBC), C-Reactive protein (CRP), and segments in comparison with non-ischemic OT patients. Multivariable regression showed increased odds of ischemic ovary torsion, associated with higher WBC (12.3 × 103/mm3 vs. 8.7 × 103/mm3, p < 0.001), CRP (50.4 mg/L vs. 8.4 mg/L, p < 0.001), and vomiting (55.1% vs. 25%, p = 0.002) than in non-ischemic patients. A receiver-operating characteristic (ROC) analysis indicated that patients with vomiting, leukocytosis, or CRP ≧ 40 mg/L were more likely to have ischemic OT (sensitivity, 92%; specificity, 54%; PPV, 79.6; NPV, 78.9%). Ischemic OT is common among pediatric OT patients. The presence of potential risk factors of vomiting, leukocytosis, and CRP more significant than 40 mg/L may assist clinicians in ensuring an expedited surgical treatment.
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12
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Singh S, Sasmal PK, Nagarajan K. CT Imaging in Predicting Ovarian Torsion: Report of Two Cases, With and Without Infarction. Cureus 2021; 13:e17082. [PMID: 34527469 PMCID: PMC8432481 DOI: 10.7759/cureus.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Ovarian torsion is one of the common abdominal and gynecologic surgical emergencies with serious morbidity in the form of ovarian infarct or necrosis. Various imaging modalities like USG, CT, and MRI have been used in the evaluation of ovarian torsion. Two middle-aged females presented with lower abdominal pain. Imaging showed an ovarian cystic lesion in the first patient and thickened and twisted ovarian pedicle or ‘helical swirling’ sign in the second. Intraoperatively, the first case turned out to be a 180* twist with mild ovarian edema and the second showed more than 720* torsion with ovarian infarction. The CT findings of twisted pedicle with pericystic fat stranding might be predictive of hemorrhagic infarction in cases of torsion.
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Affiliation(s)
- Sweta Singh
- Obstetrics and Gyenacology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Prakash K Sasmal
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Krishnan Nagarajan
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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13
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Daniilidis A, Charitidou S, Petousis S, Margioula‐Siarkou C, Liberis A, Dinas K. Isolated torsion of the fallopian tube associated with hydrosalpinx in a 17-year-old sexually inactive girl: A case report. Clin Case Rep 2021; 9:e04794. [PMID: 34552738 PMCID: PMC8443439 DOI: 10.1002/ccr3.4794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/02/2021] [Accepted: 08/22/2021] [Indexed: 11/11/2022] Open
Abstract
Isolated tubal torsion is an unusual cause of acute abdominal pain in young sexually inactive patients. However, it should be still taken into account regarding the differential diagnosis of such conditions.
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Affiliation(s)
- Angelos Daniilidis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Sonia Charitidou
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | | | - Anastasios Liberis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
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14
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Reimer RP, Heneweer C, Juchems M, Persigehl TT. [Imaging in the acute abdomen-part 2 : Case examples of frequent organ-specific causes: gastrointestinal tract and urogenital system]. Radiologe 2021; 61:677-688. [PMID: 34170363 PMCID: PMC8231090 DOI: 10.1007/s00117-021-00866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/01/2022]
Abstract
The acute abdomen is a potentially life-threatening condition and requires a rapid diagnosis. After clinical inspection and in cases with unclear ultrasound findings or unclear serious symptoms computed tomography (CT) and in pregnant women and children magnetic resonance imaging (MRI) is usually necessary. This second part of "Imaging in the acute abdomen" focuses on frequent organ specific causes of the gastrointestinal tract and the urogenital system.
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Affiliation(s)
- Robert Peter Reimer
- Medizinische Fakultät und Universitätsklinikum Köln, Institut für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Carola Heneweer
- Medizinische Fakultät und Universitätsklinikum Köln, Institut für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Markus Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Konstanz, Deutschland
| | - Thors Ten Persigehl
- Medizinische Fakultät und Universitätsklinikum Köln, Institut für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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15
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Trinci M, Danti G, Di Maurizio M, Tursini S, Briganti V, Galluzzo M, Miele V. Can contrast enhanced ultrasound (CEUS) be useful in the diagnosis of ovarian torsion in pediatric females? A preliminary monocentric experience. J Ultrasound 2021; 24:505-514. [PMID: 34176094 DOI: 10.1007/s40477-021-00601-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/29/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe contrast enhanced ultrasound (CEUS) characteristics of ovarian torsion in pediatric females, assessing the potential diagnostic advantages of method as well as its limitations. MATERIALS AND METHODS A retrospective study design was used. Between January 2018 and December 2020 we analyzed all pediatric females who underwent explorative surgery with a suspected diagnosis of ovarian torsion, and who were previously evaluated by conventional ultrasound (US), color-Doppler ultrasound (CDUS) and CEUS. RESULTS We examined twenty pediatric females with a median age of 12 years. US identified 9/20 ovarian complex masses against 13/20 by CEUS. At US abdominal free fluid was shown in 13/20 patients and in 18/20 cases with CEUS. In our case series the evaluation of contrast enhancement at CEUS in the detection of ovarian torsions revealed a sensitivity of 94.1%, a specificity of 100% and an overall accuracy of 95%. CONCLUSION Although there is a known ultrasound semeiotics suggestive of ovarian torsion, it is not always possible to obtain a diagnosis of certainty with conventional US even with CDUS. The study reports that complementation with CEUS showed excellent agreement with surgery obtaining a diagnosis in almost all the pediatric females examined.
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Affiliation(s)
- Margherita Trinci
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Marco Di Maurizio
- Department of Radiology, Azienda Ospedaliero-Universitaria Meyer, Largo Piero Palagi, 1, 50139, Florence, Italy
| | - Stefano Tursini
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Vito Briganti
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Michele Galluzzo
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
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Wang Q, Yu D, Wang F. Clinical and Computed Tomographic Features of Ovarian Lesions in Infants, Children, and Adolescents: A Series of 222 Cases. J Pediatr Adolesc Gynecol 2021; 34:387-393. [PMID: 33144230 DOI: 10.1016/j.jpag.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To investigate the clinical and computed tomography (CT) characteristics of ovarian lesions in infants, children, and adolescents. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the clinical and CT data was performed in 222 patients who were 20 years or younger with ovarian lesions. Patients' age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded. INTERVENTIONS None. MAIN OUTCOME MEASURES Identification of the clinical and CT features of ovarian lesions in infants, children, and adolescents. RESULTS A total of 136 patients had abdominal pain, and 73 patients had palpable abdominal mass. The β-HCG was elevated in 4 and AFP was elevated in 16 of the 222 cases. A total of 235 lesions were found in 222 cases, including 75 non-neoplastic and 160 neoplastic lesions. Ovarian cyst exhibited homogeneous low density. The torsion of a normal-sized ovary demonstrated mild or no enhancement. The torsion associated with an ovarian mass demonstrated a thickened, hyperdense wall. Mature teratoma presented as a cystic mass, with bulk fat and coarse calcification. Immature teratoma appeared as a solid mass with foci of fat and fine calcification. Yolk sac tumor was shown as cystic-solid mass with intense enhancement of solid component. Wall and septation of benign epithelial tumors were relatively uniform in thickness; mural nodule was detected in borderline tumor; and malignant epithelial tumor was predominantly a solid mass with intense enhancement. CONCLUSION Ovarian cyst is the most common non-neoplastic lesion. Torsion of a normal-sized ovary was the second most common non-neoplastic lesion, almost always causing abdominal pain. Germ cell tumor has the highest incidence among neoplastic lesions. Fat and calcification are highly specific for germ cell tumor. The elevation of AFP and HCG levels in serum indicates germ cell tumor. Ovarian epithelial tumor is usually large, benign, and predominantly cystic. The combination of clinical and imaging features is helpful for correct diagnosis.
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Affiliation(s)
- Qing Wang
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China
| | - Dexin Yu
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China
| | - Fang Wang
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China.
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17
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A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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18
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Adam Osman A, Tahtabasi M, Gedi Ibrahim I, Issak Hussein A, Mohamud Abdullahi I. Ovarian Torsion Due to Mature Cystic Teratoma During the Early Postpartum Period: A Rare Case Report. Int Med Case Rep J 2021; 14:333-338. [PMID: 34045903 PMCID: PMC8146748 DOI: 10.2147/imcrj.s310071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Mature cystic teratoma (MCT) is a benign and unilateral ovarian neoplasm usually seen in premenopausal women. Its most common complication, torsion, is a well-known cause of acute abdominal pain. However, it is rare in the early postpartum period. In this paper, we present a case of ovarian torsion due to MCT, which was diagnosed radiologically in the early postnatal period and surgically confirmed. A 25-year-old woman vaginally delivered a healthy baby on time and without any problems. She presented with acute abdominal pain in the right lower quadrant on the postpartum 5th day. Abdominal ultrasound (US) and computed tomography (CT) demonstrated an ovarian mass containing fat and calcification in the right adnexa and non-enhancing ovarian parenchyma. The patient was discharged on the 5th day after the salpingo-oophorectomy operation without any complications. US and CT provided crucial information to make an accurate and rapid management decision in ovarian torsion due to MCT.
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Affiliation(s)
- Ahmed Adam Osman
- Department of Radiology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Ismail Gedi Ibrahim
- Department of Radiology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Ahmed Issak Hussein
- Department of Obstetrics and Gynecology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Ismail Mohamud Abdullahi
- Department of Pathology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
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19
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GEZER Ş, BAKKAL Ö, YÜCESOY İ. Over torsiyonunda ultrasonografi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme yöntemlerinin tanısal değeri. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.771553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Dighe M. Invited Commentary: Adnexal Torsion-Seven Tips to Not Miss the Diagnosis at Imaging. Radiographics 2021; 41:E57-E59. [PMID: 33646905 DOI: 10.1148/rg.2021210002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manjiri Dighe
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
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21
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Henrichsen TL, Maturen KE, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Friedman L, Learman LA, Patlas MN, Sadowski EA, Saphier C, Wasnik AP, Glanc P. ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain. J Am Coll Radiol 2021; 18:S119-S125. [PMID: 33958106 DOI: 10.1016/j.jacr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia, Vice Chair of Research, Department of Radiology, Medstar Georgetown University Hospital
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio, American Congress of Obstetricians and Gynecologists, Director, Center of Endometriosis, Co-director, Chronic Pelvic Pain, Associate Program Director, Fellowship in Minimally Invasive Gynecologic Surgery, Cleveland Clinic
| | - Lucas Friedman
- University of California Riverside, Riverside, California, American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, American Congress of Obstetricians and Gynecologists, Dean, Virginia Tech Carilion School of Medicine
| | - Michael N Patlas
- McMaster University, Hamilton, Ontario, Canada, Editor-in-Chief, Canadian Association of Radiologists Journal
| | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey, American Congress of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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22
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Bent C, Thomson B, Kief-Garcia M. Ovarian torsion after hysterectomy and oophoropexy. Radiol Case Rep 2021; 16:1646-1649. [PMID: 34007376 PMCID: PMC8111456 DOI: 10.1016/j.radcr.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022] Open
Abstract
Ovarian torsion (OT) is a medical emergency which can have significant clinical consequences. It is surgically treated by either detorsion with or without oophoropexy, or oophorectomy. In this report, a case of left OT is described after prior hysterectomy and bilateral prophylactic oophoropexy three years prior. The patient presented with progressive left flank and abdominal pain. The diagnosis of torsion was made using a combination of CT and MR imaging with confirmation at surgery and pathology. At laparoscopic surgery, the left ovary was found at the level of iliac crest posterior to the descending colon. The ovary was torsed with hemorrhagic infarction. It was successfully removed. The patient was discharged postoperative day one and is now free of symptoms and complaints. OT is rarely reported after hysterectomy and oophoropexy. This case demonstrates that OT should be kept in the differential even in patients post hysterectomy and/or oophoropexy.
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23
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Duan N, Chen X, Rao M, Zhou C, Wang Z. CT predictive model for torsion angle as a marker for risk of necrosis in patients with adnexal torsion. Clin Radiol 2021; 76:540-546. [PMID: 33863549 DOI: 10.1016/j.crad.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the feasibility of preoperative computed tomography (CT) prediction of torsion angle for stratifying the risk of necrosis in patients with adnexal torsion. MATERIALS AND METHODS In this multicentre, retrospective study, 72 patients underwent preoperative CT and surgically verified adnexal torsion. Surgeons identified the torsion angle and adnexal necrosis requiring adnexectomy. The twisted angles were compared between conservative surgery group and salpingo-oophorectomy group. Variables included demographic, pathological and CT details. Logistic analysis was used to identify the indicators of twisted angle associated with high-risk necrosis. RESULTS The necrosis associated with adnexal torsion treated with adnexectomy was performed more often in patients with a torsion angle of ≥720° (odds ratio [OR]=7, 95% confidence interval [CI]: 1.314-37.295, p=0.023). The enlarged twisted pedicle (OR=14.592, 95% CI: 2.048-103.953, p=0.007) and pedicle haemorrhage (OR=5.612, 95% CI: 1.088-28.941, p=0.039) can predict a torsion angle of ≥720°, and area under the receiver operating characteristic (ROC) curve (AUC=0.758±0.058) was generated with the combined variables. CONCLUSION The risk of adnexal necrosis is high in patients with torsion angle of ≥720°. CT findings of enlarged twisted pedicle and pedicle haemorrhage can be used to predict torsion angle of ≥720° and can imply adnexal necrosis indirectly.
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Affiliation(s)
- N Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - X Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - M Rao
- Department of Radiology, Ruijin Hospital North of the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Zhou
- Department of Radiology, The first Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Z Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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24
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Kinay T, Akgul MA, Kiykac Altinbas S, Tapisiz OL, Kayikcioglu F, Moraloglu Tekin O. Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases. J Obstet Gynaecol Res 2021; 47:1846-1853. [PMID: 33650213 DOI: 10.1111/jog.14715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/26/2020] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p < 0.001). According to the ROC curve analyses, the optimal cut-off value for NLR and PLR were 2.51 (sensitivity, 72%; specificity, 78%) and 154.4 (sensitivity, 61%; specificity, 64%) in the diagnosis of adnexal torsion, respectively. CONCLUSION NLR and PLR have been found useful hematological markers for the diagnosis of adnexal torsion. NLR and PLR could be helpful in cases, which is difficult to make a definitive diagnosis with patients' symptom and the ultrasonographic examination.
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Affiliation(s)
- Tugba Kinay
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Mehmet A Akgul
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Sadiman Kiykac Altinbas
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Omer L Tapisiz
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Fulya Kayikcioglu
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynaecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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25
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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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26
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Meyer R, Meller N, Mohr-Sasson A, Abu-Bandora E, Cohen A, Tamir M, Mashiach R, Levin G. Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion. Int J Gynaecol Obstet 2021; 155:411-416. [PMID: 33629355 DOI: 10.1002/ijgo.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a risk score for preoperative prediction of recurrent adnexal torsion (rAT) among women with a history of previous adnexal torsion (AT). METHODS A retrospective cohort study. We included women with a history of AT, presenting with suspected rAT who underwent diagnostic laparoscopy between March 2011 and March 2020. We compared women with rAT to those without. We constructed a prediction score and validated it in a prospectively collected cohort between April 2020 and June 2020. RESULTS One hundred and fifteen women composed the study cohort. Recurrent AT was confirmed laparoscopically in 86 (74.8%) cases. A risk score for rAT was developed, based on three associated factors: enlarged ovary, no previous oophoropexy and current IVF treatment. In the construction cohort, the rate of torsion was 44.4%, 67.9%, 82.9% and 100% if none, one, two, or three risk factors were present, respectively. In the prospective validation of the risk score, the prediction of one and two risk factors was 60.0% and 100% respectively. CONCLUSION Enlarged ovary is independently associated with preoperative rAT diagnosis. Coupled with information regarding the previous surgical approach in previous AT and current IVF use, these factors could be used to efficiently predict rAT among women with a previous AT.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Mordechai Tamir
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of medicine, Hebrew University, Jerusalem, Israel
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27
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Li D, Zhang J, Kiryu S, Zhang X, Wang F. Clinical and CT features of ovarian torsion in infants, children and adolescents. Int J Gynaecol Obstet 2021; 156:444-449. [PMID: 33621364 DOI: 10.1002/ijgo.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the clinical features and computed tomography (CT) findings of pediatric ovarian torsion. METHODS A retrospective analysis of the clinical and CT data of 61 newborns, infants, children, and adolescents with ovarian torsion confirmed by histopathology was performed. RESULTS Clinical features included abdominal mass, abdominal pain, nausea and vomiting, and fever. The tumor marker α-fetoprotein was increased in five cases. Ovarian enlargement was found in 26 cases, and follicles were detected in the peripheral region of the ovary in 21 cases. Twenty-one cases presented as solid mixed-density masses on CT images. A total of 30 cases of ovarian torsion were associated with a benign ovarian mass. Among 27 cases of cystic or predominantly cystic masses, the mass had a thickened wall in 26 cases and showed an uneven density in 23 cases. Among all 61 patients, a torsed pedicle was detected in 47 cases. A torsed ovary or mass exhibited mild contrast enhancement in seven cases. Uterine deviation toward the involved side, blurred fat space around lesions, and pelvic free fluid were also found. CONCLUSION Pediatric ovarian torsion presents a relatively characteristic CT appearance. Correct diagnosis can be established based on clinical and imaging features.
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Affiliation(s)
- Dumin Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Jingwen Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shigeru Kiryu
- Department of Radiology, Narita Hospital, International University of Health and Welfare, Narita, Japan
| | - Xiaoming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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Dawood MT, Naik M, Bharwani N, Sudderuddin SA, Rockall AG, Stewart VR. Adnexal Torsion: Review of Radiologic Appearances. Radiographics 2021; 41:609-624. [PMID: 33577417 DOI: 10.1148/rg.2021200118] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- M Taufiq Dawood
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Mitesh Naik
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Nishat Bharwani
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Siham A Sudderuddin
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Andrea G Rockall
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Victoria R Stewart
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
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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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Batchala PP, Nepal P, Wankhar B, Chinnakaruppan S, Khanna M, Ojili V. "Perifollicular rim sign" in an enlarged ovary-an additional non-contrast CT finding in ovarian torsion. Emerg Radiol 2021; 28:621-626. [PMID: 33496896 DOI: 10.1007/s10140-021-01904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To look for the presence of "perifollicular rim sign" on non-contrast CT in surgically proven cases of ovarian or adnexal torsion. METHODS A retrospective analysis of abdominopelvic non-contrast CT examinations in surgically proven cases of ovarian or adnexal torsion was conducted seeking the presence of "perifollicular rim sign" in torsed ovaries. "Perifollicular rim sign" was defined as a complete ring of perifollicular hyperdensity around ovarian follicles with an attenuation value of > 50 HU and thickness > 1-2 mm. A positive sign was equated to the presence of perifollicular hemorrhage. Pre-operative non-contrast CT was available in 7 out of the 39 ovarian or adnexal torsions included in our study. RESULTS "Perifollicular rim sign" was present in 5 out of the 7 ovarian torsions on pre-operative non-contrast CT. MRI correlation was available in one patient. Ovarian enlargement (>4 cm) was present in all 7 cases. CONCLUSION In an appropriate clinical setting, presence of "perifollicular rim sign" in an enlarged ovary on non-contrast CT examination can be considered a useful additional sign for ovarian torsion.
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Affiliation(s)
- Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22908, USA.
| | - Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, 06606, USA
| | - Baphiralyne Wankhar
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, 793012, India
| | - Shanmugavel Chinnakaruppan
- Department of Clinical Imaging, Al Khor Hospital, Hamad Medical Corporation, P O Box 3050, Al Khor, Qatar
| | - Maneesh Khanna
- Wollongong Diagnostics, 340 Crown Street, Wollongong, NSW, 2500, Australia
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, 78229, USA
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Anfelter P, Testa A, Chiappa V, Froyman W, Fruscio R, Guerriero S, Alcazar JL, Mascillini F, Pascual MA, Sibal M, Savelli L, Zannoni GF, Timmerman D, Epstein E. Imaging in gynecological disease (17): ultrasound features of malignant ovarian yolk sac tumors (endodermal sinus tumors). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:276-284. [PMID: 32119168 DOI: 10.1002/uog.22002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the clinical and sonographic characteristics of malignant ovarian yolk sac tumors (YSTs). METHODS In this retrospective multicenter study, we included 21 patients with a histological diagnosis of ovarian YST and available transvaginal ultrasound images and/or videoclips and/or a detailed ultrasound report. Ten patients identified from the International Ovarian Tumor Analysis (IOTA) studies had undergone a standardized preoperative ultrasound examination, by an experienced ultrasound examiner, between 1999 and 2016. A further 11 patients were identified through medical files, for whom ultrasound images were retrieved from local image workstations and picture archiving and communication systems. All tumors were described using IOTA terminology. The collected ultrasound images and videoclips were used by two observers for additional characterization of the tumors. RESULTS All cases were pure YSTs, except for one that was a mixed tumor (80% YST and 20% embryonal carcinoma). Median age at diagnosis was 25 (interquartile range (IQR), 19.5-30.5) years. Seventy-six percent (16/21) of women had an International Federation of Gynecology and Obstetrics (FIGO) Stage I-II tumor at diagnosis. Fifty-eight percent (11/19) of women felt pain during the ultrasound examination and one presented with ovarian torsion. Median serum α-fetoprotein (S-AFP) level was 4755 (IQR, 1071-25 303) µg/L and median serum CA 125 level was 126 (IQR, 35-227) kU/L. On ultrasound assessment, 95% (20/21) of tumors were unilateral. The median maximum tumor diameter was 157 (IQR, 107-181) mm and the largest solid component was 110 (IQR, 66-159) mm. Tumors were classified as either multilocular-solid (10/21; 48%) or solid (11/21; 52%). Papillary projections were found in 10% (2/21) of cases. Most (20/21; 95%) tumors were well vascularized (color score, 3-4) and none had acoustic shadowing. Malignancy was suspected in all cases, except in the patient with ovarian torsion, who presented a tumor with a color score of 1, which was classified as probably benign. Image and videoclip quality was considered as adequate in 18/21 cases. On review of the images and videoclips, we found that all tumors contained both solid components and cystic spaces, and that 89% (16/18) had irregular, still fine-textured and slightly hyperechoic solid tissue, giving them a characteristic appearance. CONCLUSION Malignant ovarian YSTs are often detected at an early stage, in young women usually in the second or third decade of life, presenting with pain and markedly elevated S-AFP. On ultrasound, malignant ovarian YSTs are mostly unilateral, large and multilocular-solid or solid, with fine-textured slightly hyperechoic solid tissue and rich vascularization. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology..
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Affiliation(s)
- P Anfelter
- Department of Obstetrics and Gynecology, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
| | - A Testa
- Department of Gynecological Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - V Chiappa
- Department of Obstetrics and Gynecology, National Cancer Institute, Milan, Italy
| | - W Froyman
- Department of Obstetrics and Gynecology, University Hospital KU Leuven, Leuven, Belgium
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - F Mascillini
- Department of Gynecological Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - M Sibal
- Department of Obstetrics and Gynecology, Manipal Hospital, Bangalore, India
| | - L Savelli
- Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - G F Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospital KU Leuven, Leuven, Belgium
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
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Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2020; 27:236-242. [PMID: 32713824 DOI: 10.1016/j.radi.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Ovarian torsion (OT), although rare, can be described as a complete or partial twist of the ovary with impairment of blood flow. Although occurring at any age, it is more common in children and during pregnancy. Presenting symptoms are non-specific but include either persistent or intermittent acute abdominal pain, making early diagnosis difficult. Delayed diagnosis is associated with an increased need for oophorectomy. The aim of this literature review is to establish the safest and most efficacious imaging strategy for OT by comparing and contrasting evidence for current imaging modalities found in the literature. KEY FINDINGS Characteristically, OT can be identified through a combination of findings some of which includes an enlarged ovary, multiple follicles at the periphery and a "whirlpool" sign. Currently, ultrasound is the preferred primary imaging modality; although computed tomography (CT) and magnetic resonance imaging (MRI) may also be used when findings are equivocal; with MRI being the safer option. CONCLUSION Ultimately, while it is true that ovarian torsion is not a common cause of acute abdominal pain in children, it should always be considered in the differential diagnosis. Prior to selecting an imaging modality; the clinical presentation, age group, possible radiation dose and availability of the modality needs to be considered to ensure the appropriate imaging strategy. IMPLICATIONS FOR PRACTICE With new tools such as scoring systems, B-flow imaging (BFI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) currently being explored for possible use in the future, early diagnosis of OT may be attainable. Thus, reducing the likelihood of adverse complications and consequently the need for oophorectomy.
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Affiliation(s)
- S Gounder
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia.
| | - M Strudwick
- Centre for Advanced Imaging, University of Queensland, St Lucia, Queensland, Australia
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Lee JH, Roh HJ, Ahn JW, Kim JS, Choi JY, Lee SJ, Lee SH. The Diagnostic Accuracy of Magnetic Resonance Imaging for Maternal Acute Adnexal Torsion during Pregnancy: Single-Institution Clinical Performance Review. J Clin Med 2020; 9:jcm9072209. [PMID: 32668570 PMCID: PMC7408813 DOI: 10.3390/jcm9072209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/04/2022] Open
Abstract
Background: For acute adnexal torsion of pregnant women, appropriate treatment based on an accurate diagnosis is especially important for fertility preservation and timely treatment. The 2017 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 723 announced its practice-changing guidelines to ensure that diagnostic magnetic resonance imaging (MRI) conducted during the first trimester and gadolinium exposure at any time during pregnancy are safe for fetal stability. Unfortunately, few studies have been performed to evaluate the usefulness of the diagnostic accuracy of MRI for acute adnexal torsion during pregnancy. Objective: We sought to determine the efficacy of diagnostic MRI modality using multiparameter for maternal adnexal torsion during pregnancy. Methods: From 1 January 2007 to 31 January 2019, 131 pregnant with MRI tests were reviewed. In this retrospective cohort study, 94 women were excluded due to conditions other than an adnexal mass, and 37 were identified through MRI analyses conducted before surgery for suspected adnexal torsion. The primary outcome was the diagnostic accuracy of sonography and MRI, and the secondary outcome was the usefulness of Apparent diffusion coefficient (ADC) values for predicting the severity of hemorrhagic infarction between the medulla and cortex of the torsed ovarian parenchyma. Results: Our study demonstrates that in the diagnosis of adnexal torsion during pregnancy, the sensitivity, specificity, positive predictive value, and negative predictive value are 62.5%, 83.3%, 90.9%, and 45.5% for sonography and 100%, 77.8%, 90.5%, and 100% for MRI. MRI results in surgical-proven adnexal torsion patients revealed unilocular ovarian cysts (36.8% (7/19)), multilocular ovarian cysts (31.6% (6/19)), and near normal-appearing ovaries (31.6% (6/19)). Pathology in adnexal torsion revealed a corpus luteal ovarian cyst (63.2% (12/19)) and underlying adnexal pathology (46.8% (7/19)). Maternal adnexal torsion during pregnancy was more likely to occur in corpus luteal ovarian cysts than in underlying adnexal masses (odds ratio, 2.14; 95% confidence interval (CI), 0.428–10.738). MRI features for adnexal torsion were as follows: tubal wall thickness, 100% (19/19); ovarian stromal (medullary) edema, 100% (19/19); symmetrical or asymmetrical ovarian cystic wall, 100%(19/19); prominent follicles in the ovarian parenchyma periphery, 57.9% (11/19); periadenxal fat stranding, 84.2% (16/19); uterine deviation to the twisted side, 21.1% (4/19); and peritoneal fluid, 42.1% (8/19). The signal intensity of the ADC values of the ovarian medulla and cortex were compared between the cystectomy and detorsion (CD) and salpingo-oophorectomy (SO) groups. The ADC values of the CD and SO groups were 1.81 ± 0.09 × 10−3 mm2/s and 1.91 ± 0.18 × 10−3 mm2/s, respectively (P = 0.209), in the ovarian medulla and 1.37 ± 0.32 × 10−3 mm2/s and 0.96 ± 0.36 × 10−3 mm2/s, respectively (P = 0.022), in the ovarian cortex. The optimal cut-off value of ADC values for predictable total necrosis in the torsed ovarian cortex was ≤ 1.31 × 10−3 mm2/s (area under the curve (AUC) = 0.81; 95% CI 0.611–1.0; P = 0.028). Conclusion: Our data showed that maternal adnexal torsion during pregnancy occurred in most corpus luteal cystic ovary cases and some normal-appearing ovary during the 1st and 2nd trimesters of gestation. Therefore, this study is the first study to elaborate on the existence or usefulness of the diagnostic MRI for acute maternal adnexal torsion during pregnancy and to provide a predictive diagnosis of the severity of hemorrhagic infarction for deciding surgical radicality.
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Affiliation(s)
- Jong Hwa Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea;
| | - Hyun Jin Roh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
| | - Jun Woo Ahn
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
| | - Jeong Sook Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
| | - Jin Young Choi
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
| | - Sang Hun Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, 44033 Ulsan, Korea; (H.J.R.); (J.W.A.); (J.S.K.); (J.Y.C.); (S.-J.L.)
- Correspondence: ; Tel.: +82-052-250-8086; Fax: +82-052-250-7163
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Siviero I, da Silva de Oliveira JT, Forny DN, Méio IB, Bertrand Simões BC, Rezende Penna CR, Antunes Chagas VL. Torsion of Granulosa Cell Tumor of the Ovary in a Preschool Patient: A Rare Cause of Acute Abdomen. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921689. [PMID: 32335578 PMCID: PMC7200090 DOI: 10.12659/ajcr.921689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 5-year-old Final Diagnosis: Granulosa cell tumor of the ovary Symptoms: Abdomen distension • abdominal mass • abdominal pain Medication:— Clinical Procedure: Diagnostic tests, surgical treatment and chemotherapy Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Ivonete Siviero
- Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Jeferson Tobias da Silva de Oliveira
- Teaching Division, Pediatric Surgery Service of The Peuriculture and Pediatrics Institute of Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Danielle Nunes Forny
- Teaching Division, Pediatric Surgery Service of The Peuriculture and Pediatrics Institute of Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ivens Baker Méio
- Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Betina Carla Bertrand Simões
- Teaching Division, Pediatric Surgery Service of The Peuriculture and Pediatrics Institute of Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Claudia Renata Rezende Penna
- Imaging Department of The Peuriculture and Pediatrics Institute of Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Vera Lúcia Antunes Chagas
- Department of Pathology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Balasubramaniam D, Duraisamy KY, Ezhilmani M. Laparoscopic Detorsion and Fertility Preservation in Twisted Ischemic Adnexa - A Single-Center Prospective Study. Gynecol Minim Invasive Ther 2020; 9:24-28. [PMID: 32090009 PMCID: PMC7008646 DOI: 10.4103/gmit.gmit_20_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/20/2019] [Accepted: 09/25/2019] [Indexed: 01/21/2023] Open
Abstract
Objective: This study aimed to analyze our experience about the salvageability of ovary in cases of adnexal torsion by laparoscopy, irrespective of the grade of necrosis and number of twists, and to assess the subsequent ovarian viability. Materials and Methods: This is a prospective study conducted in a tertiary care laparoscopic institute. All the cohorts of intraoperative diagnosis of adnexal torsion were included irrespective of the age group from January 2015 to January 2018 over the period of 3 years after obtaining approval from the institute's human ethics committee. Their demographic details and clinical and operative findings were entered after obtaining an informed written consent. All patients underwent laparoscopy except those with a suspicious diagnosis of malignancy. Postoperatively, ovarian viability was assessed by ultrasound Doppler in terms of vascularity and follicular development at 1, 6, and 12 months. Results: A total of 84 patients were included in the study. Acute abdominal pain (71.4%) was the main presenting symptom in all age groups. The total number of cases of adnexal torsion was 69. Adnexal torsion was mainly diagnosed in young and adolescent girls. Out of 46 attempted detorsion, 45 ovaries were preserved (97.8%). Most of the pathologies were benign. All the preserved ovaries were showing follicles and vascularity during ultrasound follow-up. Conclusion: Laparoscopic detorsion of the ovary is the best treatment modality irrespective of the grade of ischemia. Ovarian structure and follicles were preserved following detorsion in all the cases, even in gravely ischemic ovaries.
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Affiliation(s)
- Devi Balasubramaniam
- Department of Endogynecology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | | | - Malathi Ezhilmani
- Department of Endogynecology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Tonolini M, Foti PV, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion. Insights Imaging 2019; 10:119. [PMID: 31853900 PMCID: PMC6920287 DOI: 10.1186/s13244-019-0808-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Bekci T, Unal E, Polat AV. “T2-hypointense dot sign”: A novel and highly suggestive clue for the diagnosis of ovarian torsion. Clin Imaging 2019; 56:69-72. [DOI: 10.1016/j.clinimag.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
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Kolovos G, Meytap E, Samartzis N, Kalaitzopoulos DR. Isolated torsion of the fallopian tube in a 16-year-old girl: A case report and review of the literature. Case Rep Womens Health 2019; 23:e00132. [PMID: 31316898 PMCID: PMC6611968 DOI: 10.1016/j.crwh.2019.e00132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/24/2022] Open
Abstract
Torsion of the fallopian tube is when the tube twists on the axis created between the infundibulopelvic ligament and the utero-ovarian ligament. It most commonly presents with appendicitis-like symptoms, such as abdominal pain, nausea and vomiting. Because of its rarity and non-specific symptoms, it is usually misdiagnosed initially, which delays therapy, at the expense of the preservation of fertility. This case report of a 16-year-old girl who had never had sexual intercourse presents an example of the misdiagnosis of fallopian tube torsion. The definitive diagnosis was based on laparoscopy. We summarize our experience and provide our conclusions after reviewing the literature.
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Affiliation(s)
- GeorgiosN Kolovos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmy Meytap
- Department of Gynecology and Obstetrics, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, Switzerland
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George MP, Kim WG, Lee EY. Tales from the Night:: Emergency MR Imaging in Pediatric Patients after Hours. Magn Reson Imaging Clin N Am 2019; 27:409-426. [PMID: 30910105 DOI: 10.1016/j.mric.2019.01.013] [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: 11/26/2022]
Abstract
Overnight in-house radiology has rapidly become an important part of contemporary practice models, and is increasingly the norm in pediatric radiology. MR imaging is an indispensable first-line and problem-solving tool in the pediatric population. This has led to increasingly complex MR imaging being performed "after hours" on pediatric patients. This article reviews the factors that have led to widespread overnight subspecialty radiology and the associated challenges for overnight radiologists, and provides an overview of up-to-date imaging techniques and imaging findings of the most common indications for emergent MR imaging in the pediatric population.
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Affiliation(s)
- Michael P George
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Wendy G Kim
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
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[Ovarian or tubal ?]. Presse Med 2019; 48:336-339. [PMID: 30853290 DOI: 10.1016/j.lpm.2019.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/28/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022] Open
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Foster G, Keene J. Isolated fallopian tubal torsion: A challenging ultrasound diagnosis. SONOGRAPHY 2019. [DOI: 10.1002/sono.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Grant Foster
- Medical Imaging; The Women's Hospital; Melbourne Australia
- BMI; Barwon Health; Geelong Australia
| | - Jacqueline Keene
- Medical Imaging; The Women's Hospital; Melbourne Australia
- Specialist Imaging for Women; Melbourne Australia
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Budhram G, Elia T, Dan J, Schroeder M, Safain G, Schlech W, Friderici J, Knee A, Anthouard M, Schoenfeld E. A Case-Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain. Acad Emerg Med 2019; 26:152-159. [PMID: 30044031 DOI: 10.1111/acem.13523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Color and power Doppler ultrasound are commonly used in the evaluation of ovarian torsion but are unreliable. Because normal-sized ovaries are unlikely to cause torsion, maximum ovarian diameter (MOD) could theoretically be used as a screening test in the ED. Identification of MOD values below which torsion is unlikely would be of benefit to providers interpreting radiology department or point-of-care pelvic ultrasound. OBJECTIVES The objective was to determine if sonographic MOD can be used as a screening tool to rule out torsion in selected patients. METHODS Via a retrospective case-control study spanning a 14-year period, we examined the ultrasound characteristics of patients with torsion and age-matched controls, all presenting to the emergency department with lower abdominal pain and receiving a radiology department pelvic ultrasound for "rule-out torsion." Standardized data collection forms were utilized. Distributions of MOD were compared and sensitivity, specificity, and likelihood ratios were calculated for multiple cutoffs. RESULTS We identified 92 cases of surgically confirmed ovarian torsion and selected 92 age-matched controls. In postmenarchal patients the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 3- and 5-cm MODs were 100% (96%-100%), 30% (20%-41%), 1.4 (1.3-1.7), and 0 and 91% (83%-97%), 92% (83%-97%), 11.2 (5.5-22.9), and 0.09 (0.04-0.19), respectively. The 5-cm MOD, however, excluded an additional 52 of 84 (62%) postmenarchal patients. CONCLUSIONS A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.
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Affiliation(s)
- Gavin Budhram
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Tala Elia
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Jeff Dan
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Michele Schroeder
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Golien Safain
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Cambridge Health Alliance Cambridge MA
| | - Walter Schlech
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Berkshire Medical Center Pittsfield MA
| | - Jennifer Friderici
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Alex Knee
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Magalie Anthouard
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Manatee Memorial Hospital Bradenton FL
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
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Adeyemi-Fowode O, Lin EG, Syed F, Sangi-Haghpeykar H, Zhu H, Dietrich JE. Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution. J Pediatr Adolesc Gynecol 2019; 32:64-69. [PMID: 30012428 DOI: 10.1016/j.jpag.2018.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE Adnexal torsion (AT) requires urgent surgical intervention to preserve ovarian function. Historically, treatment for AT was oophorectomy because of concerns related to leaving a nonviable ischemic ovary. No published studies support these theoretical concerns and current literature supports conservative management. The aim of this study was to review the institutional outcomes for AT cases, including salvage rates and complications. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This study was approved by the institutional review board at Baylor College of Medicine. A retrospective chart review on cases of AT from 2007 to 2016 at a single Children's hospital was performed on the basis of International Classification of Diseases, 10th revision and Current Procedural Terminology codes. A standardized chart review form was used in data extraction. Statistical analysis was performed using SAS version 9.4 (SAS Institute). RESULTS Chart review identified 245 torsion cases in 237 patients. The mean age was 12.4 ± 3.29 years. Of the participants, 230 (94%) underwent minimally invasive laparoscopy with ovarian preservation in 233 (95%) of the cases. There were no complications due to detorsion of the affected adnexa. Intraoperatively, the right adnexa was affected in 134 (55%) cases and a lesion was noted in 193 (79%) cases, most commonly paratubal cysts and mature teratomas. The malignancy rate was low, noted only in 4/245 patients at (1.2%). Pediatric gynecology performed most of the cases (n = 214; 87%). CONCLUSION The findings of our study continue to support the conservative management of patients with AT.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Emily G Lin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Fatima Syed
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Hirshberg B, Rheinboldt M. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emerg Radiol 2019; 26:205-219. [PMID: 30631995 DOI: 10.1007/s10140-018-01665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
Over the past 40 years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.
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Tanaka Y, Tsuboyama T, Yamamoto K, Terai Y, Ohmichi M, Narumi Y. A case of torsion of a normal ovary in the third trimester of pregnancy: MRI findings with emphasis on asymmetry in the diameter of the ovarian veins. Radiol Case Rep 2018; 14:324-327. [PMID: 30581517 PMCID: PMC6293029 DOI: 10.1016/j.radcr.2018.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
A 33-year-old woman, gravida two para one, at 31 weeks of gestational age experienced sudden onset of left lower quadrant pain and underwent unenhanced pelvic MRI. On fast imaging employing steady state precession (FIESTA) sequence images, a marked difference was observed in the diameters of the right and left ovarian veins. The right ovarian vein was torturous and dilated, measuring 35 mm in diameter, while the left ovarian vein was thin and linear, measuring 7 mm in diameter. The left ovary showed no apparent swelling or hemorrhage, but was suspected to have been shifted anteriorly. The patient underwent explorative laparotomy and was found to have left ovarian torsion. A difference in diameter of the ovarian veins, with thinning of the twisted side and compensatory dilatation of the contralateral side for drainage of increased uterine blood flow, may be a useful imaging sign for the diagnosis of ovarian torsion during pregnancy.
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Affiliation(s)
- Yoshikazu Tanaka
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
- Corresponding author.
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka National Hospital, Osaka, Osaka Prefecture, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
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Spectrum of magnetic resonance imaging findings in ovarian torsion. Pol J Radiol 2018; 83:e588-e599. [PMID: 30800198 PMCID: PMC6384404 DOI: 10.5114/pjr.2018.81157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/20/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose Ovarian torsion is the twisting of the ovary on its vascular pedicle resulting in vascular compromise. Diagnosis of ovarian torsion is challenging in patients who have atypical clinical or ultrasound (US) findings. The objective of our study was to demonstrate the magnetic resonance imaging (MRI) features of ovarian torsion to help radiologists make a conclusive diagnosis when the clinical and US findings are unclear. Material and methods We retrospectively reviewed the clinical and MRI features in 10 females with surgically proven ovarian torsion, who had inconclusive clinical, US, or computed tomography findings. Results All patients showed a significantly enlarged ovary with size ranging from 5 to 18 cm. 'Twisted ovarian pedicle' sign was seen in seven patients. Eight cases showed areas of haemorrhage within the ovarian stroma. Non-enhancement of ovarian stroma was observed in six patients. Seven patients showed an ipsilateral deviation of the uterus. Conclusions MRI features of ovarian torsion include ovarian enlargement, twisted ovarian pedicle, ovarian haemorrhage, abnormal ovarian enhancement, and ipsilateral deviation of the uterus. Awareness of these imaging features will enable the radiologist to recognise ovarian torsion and differentiate it reliably from other benign or malignant ovarian lesions.
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Edwards R, McCagg J, Chirico P, Yoost J. The Management of an Ectopic Ovary in an Adolescent Patient with Gastroschisis. J Pediatr Adolesc Gynecol 2018; 31:540-542. [PMID: 29730430 DOI: 10.1016/j.jpag.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 04/26/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect through which the bowel herniates into the amniotic cavity. Surgical correction of gastroschisis is performed during infancy. Gynecologic concerns have not been described in this population as either an associated anomaly or complication of surgical repair. CASE A 15-year-old nulliparous female patient presented with abdominal pain with a history of gastroschisis requiring 4 surgeries in infancy. Computed tomography scan showed an ovary located in the right upper quadrant, which was concerning for torsion. She was taken for a laparotomy with right oophorectomy after conservative management had failed. SUMMARY AND CONCLUSION Long-term gynecologic outcomes of patients with gastroschisis are not well documented. Because gastroschisis patients are known to have abdominal pain later in life, this case shows that the differential diagnosis should include etiologies beyond the gastrointestinal tract.
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Affiliation(s)
- Rachel Edwards
- Department of Obstetrics and Gynecology, Marshall University School of Medicine, Huntington, West Virginia.
| | - Jillian McCagg
- Department of General Surgery, Marshall University School of Medicine, Huntington, West Virginia
| | - Peter Chirico
- Department of Radiology, Marshall University School of Medicine, Huntington, West Virginia
| | - Jennie Yoost
- Department of Obstetrics and Gynecology, Marshall University School of Medicine, Huntington, West Virginia
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Adeyemi-Fowode O, McCracken KA, Todd NJ. Adnexal Torsion. J Pediatr Adolesc Gynecol 2018; 31:333-338. [PMID: 29653167 DOI: 10.1016/j.jpag.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/17/2022]
Abstract
Adnexal torsion is an uncommon gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support. Delay in treatment can impact fertility adversely. The objective of this report is to provide clinical recommendations based on the latest evidence. Specifically we discuss epidemiology, clinical presentation, diagnostic approach and management of adnexal torsion in adolescents.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Kate A McCracken
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Nicole J Todd
- Division of General Gynaecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada
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Lee MS, Moon MH, Woo H, Sung CK, Oh S, Jeon HW, Lee TS. CT findings of adnexal torsion: A matched case-control study. PLoS One 2018; 13:e0200190. [PMID: 29995921 PMCID: PMC6040737 DOI: 10.1371/journal.pone.0200190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/21/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The purpose of our study was to assess computed tomographic (CT) findings of adnexal torsion through a matched case-control analysis. Materials and methods This retrospective, single-institution case-control study included 43 women with adnexal torsion and 43 age- and ovarian mass-matched control women. CT images were evaluated independently by two readers for the following: prominent peripheral follicles, uterine deviation, thickened pedicles, a whirl sign, and a navel sign. Comparisons of CT findings were performed using the Chi square test and receiver operating characteristic (ROC) curves were obtained to assess the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared by using a Delong test. Results The CT findings significant for adnexal torsion were uterine deviation toward the side of the affected ovary (P = < .01 for reader 1 and P = .02 for reader 2) and thickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles (P < .01 for both readers). Thickened pedicles with ancillary findings had the highest diagnostic accuracy, as measured with ROC curves (AUC, 0.86 in reader 1 and 0.85 in reader 2). Combining uterine deviation toward the side of the affected ovary with thickened pedicles with ancillary findings did not increase the performance relative to that of thickened pedicles with ancillary findings alone. Conclusions Thickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles could be helpful for the diagnosis of adnexal torsion.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Hyunsik Woo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyu Sung
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Jeon
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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