![]() ![]() Imaging has a fundamental role in early identification, particularly given its routine use in the acute setting to triage patients with abdominopelvic pain. However, because the symptoms are nonspecific, making an early diagnosis of adnexal torsion can be challenging unless the condition is clinically suspected. The diagnosis of adnexal torsion is often made clinically with corroborative US. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen (ie, an acute intra-abdominal condition that requires surgery). To avoid ovarian infarction and the possibility of associated subfertility, early detection is critical. Despite being relatively uncommon, adnexal torsion is an important cause of morbidity, and its nonspecific manifestations can prove to be a diagnostic challenge. Less commonly, torsion of the fallopian tube in isolation or torsion of extraovarian (paratubal or paraovarian) cysts also can occur. The ovary and fallopian tube twist on their vascular and ligamental supports, causing interrupted perfusion that is initially due to venous and lymphatic congestion and subsequently caused by compromise to arterial flow. However, these terms are generally used interchangeably in clinical practice. Both the ovary and the fallopian tube typically are involved hence, the preferred term adnexal torsion rather than ovarian torsion ( 5). Torsion of the adnexa is a gynecologic emergency that affects approximately 2%–3% of females who present with acute pelvic pain ( 2– 4). Torsion is defined as the twisting of an organ or part of an organ along its own axis ( 1). Online supplemental material is available for this article. ![]() Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. 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. 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. When adnexal torsion is not clinically suspected, CT or MRI may be performed. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. ![]() 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. 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. ![]()
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