For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable. Most often seen in women of reproductive age between 20 and 40 years. Within the cyst was a daughter cyst, without significant bloodflow fig. Appropriate management of patients with an ovarian cyst depends on the presence of symptoms, likelihood of torsion or rupture, and level of concern for malignancy.
Diagnosis of ovarian torsion with color doppler sonography. Of the 83 baseline ovarian cysts, 40 persisted for an overall incidence of 48. Most ovarian cysts are benign noncancerous and cause no symptoms. Pdf adnexal torsionsymptoms, diagnosis and management. The most important risk factor for ovarian torsion is ovarian mass. Ovarian torsion or mass are two important considerations given this appearance. This is extremely important since torsion may result in the loss. Ovarian cysts can be physiologic or malignant and are known to occur in children of all ages. Ovarian cyst torsion in a toddler the american journal of. Data regarding cyst size and risk of torsion are conflicting, with some suggesting that torsion may be more likely in larger cysts 5 cm,3,5 and others suggesting. There are two different types of ovarian cysts and both may cause symptoms such as abdominal bloating, painful bowel movements, and.
Ovarian cystthe nest an ovarian cyst is a fluidfilled sac which develops in an ovary. An brief discussion of pelvic ultrasound findings in a patient with ovarian torsion. Pearls and pitfalls in diagnosis of ovarian torsion. Pearls and pitfalls in diagnosis of ovarian torsion rsna. Twenty patients who had never received cc had a baseline ovarian cyst on transvaginal ultrasound evaluation, for an incidence of. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy ie, corpus luteum cyst should increase your suspicion for torsion. How common is torsion in patients with ovarian cysts and. Nov 10, 2017 torsion can occur if the ovary is unstable. Ovarian salvage rate is below 1o% in adult due todelay in diagnosis. Ovarian cyst which ruptures, or undergoes torsion or if it shows evidence of malignancy, requires immediate surgery, irrespective of the period of gestation. Some cause problems such as pain and irregular bleeding. Apr 02, 2020 an ovarian cyst that underwent torsion twisting of the vascular pedicle. Guideline for the management of ovarian cysts in children and adolescents external link opens in a new window. Massive edema or hemorrhage within the ovary without any underlying pathologic manifestations was seen in 6 patients 40%.
Prognosis with early diagnosis and appropriate treatment,the prognosis of ovarian torsion is excellentespecially intervention with in the first 8 hrs. Ovarian torsion ucsf emergency medicine ultrasound. Ovarian torsion is a gynecological emergency that occurs when there is twisting or torsion of the ovary around its ligamentous supports. Given the history of intermittent abdominal pain and the imaging. Thus, a high index of suspicion is required to make the torsion diagnosis. Fever is uncommon, and usually lowgrade if present. Antenatally detected ovarian cystsa therapeutic dilemma. Sonographic diagnosis of ovarian torsion ucsf emergency. Ovarian torsion figures 1267 and 1268 should be strongly considered in any patient with acute onset of lower abdominal pain, particularly when it is severe and accompanied by other signs and symptoms, such as diaphoresis or vomiting. Theyre solid or fluidfilled pockets in or on your ovary. We hereby report a case of huge cyst in a 15year old girl having severe abdominal pain which was diagnosed as torsion in ovarian dermoid cyst. While the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. Diagnosis and management of adnexal torsion in children, adolescents, and adults external link opens in a new window. Ovarian tumour or cyst can be easily removed till 28 wks of gestation thereafter it is not readily accessible and may precipitate preterm labour.
Ovarian torsion is a relatively common gynaecological emergency, usually presenting as acute lower abdominal pain. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. The presence of an internal daughter cyst was confirmed fig. How common is torsion in patients with ovarian cysts and what. In this case we report a 23 yearold primigravida with 30 weeks presenting with torsion of the ovarian cyst. Ovarian torsion involves the rotation of the ovary on its ligamentous supports often leading to interruption of its blood supply and in some cases necrosis. This twisting can cut off blood flow to the ovary and fallopian tube. Commonly physiologic due to maternal hormones and resolve spontaneously. Prompt diagnosis is paramount to conserve ovarian and tubal function. If not treated quickly, it can result in loss of an ovary. Most ovarian cysts are functional in nature, and harmless benign 3. The patient presented with a short history of severe lower abdominal pain.
The incidence of ovarian torsion ranges from 2% to 5% in patients who have surgical treatment for adnexal masses. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Diagnostic features on ct and mri with pathologic correlation shauna duigenan1 esther oliva2 susanna i. Jul 25, 2019 your doctor analyzes the image to confirm the presence of a cyst, help identify its location and determine whether its solid, filled with fluid or mixed. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. An ovarian cyst that underwent torsion twisting of the vascular pedicle. In most series, the right ovary is reported to undergo torsion more often than the left 7, 8, 14, 17.
An update on the diagnosis and management of ovarian torsion. Because of the patients pain, the cystic mass, and the possibility of tubal torsion, laparoscopic surgery was performed on the patient. Ovarian torsion is frequently associated with an ipsilateral ovarian mass 50 to 81%. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. Using a laparoscope a slim, lighted instrument inserted into your abdomen through a small incision your doctor can see your ovaries and remove the ovarian cyst. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass.
You may also be more likely to develop ovarian torsion. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described 112. Ovarian torsion symptoms, diagnosis and treatment bmj. Ultrasonography us is the primary imaging modality for. Ovarian cysts are commonly encountered in gynecological imaging, and vary widely in etiology, from physiologic, to complex benign, to neoplastic.
The follicular ovarian cyst is the most common kind of ovarian cyst. A twisting of the ovary andor fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary. Ovarian torsion tayra lucero for littlethings ovarian torsion is a serious medical condition that usually develops when an ovarian cyst grows large enough to weigh down the ovary. Pathology small cystic ovarian structures should be considered normal ovarian follicles unless the. If left untreated, it results in loss of blood supply to. Paratubal cyst with isolated torsion of the fallopian tube.
Casecontrol study comparing the sensitivity and specificity of. This topic will focus mainly on ovarian torsion, but isolated fallopian tube torsion and torsion of paratubal, broad ligament, or paraovarian cysts. Ovarian cysts and torsion in assisted reproduction and pregnancy an ovarian cyst 25 mm simple or complex cyst can be found in up to 5% of pregnancies,19 with a % torsion rate. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary.
The number of diagnoses of ovarian cysts has increased with the widespread implementation of regular physical examinations and ultrasonographic technology. The main causes for surgical intervention for the studied ams was ruptured ovarian cyst in 27. In most cases, the ovarian mass or cyst is a benign tumorous growth rather than a malignant one. Ovarian torsion is the fifth most common gynecological emergency condition and for that, delayed diagnosis is not uncommon leading to disastrous results as ovarian infarction and necrosis.
The most common adnexal mass associated with ovarian torsion is an ovarian dermoid cyst. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas. The most common precipitating factor for ovarian torsion is the presence of an ovarian cyst or mass which rotates the ovary around the infundibulopelvic and uteroovarian ligaments. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign. Ovarian torsion is a common gynaecological emergency with the majority of cases occurring in women of reproductive age.
Of the 466 transvaginal ultrasound examinations, 83 revealed baseline ovarian cysts. The primary risk factor for ovarian torsion is an ovarian mass approach to the patient with an adnexal mass view in chinese a woman with an adnexal mass may be associated with adnexal torsion, rupture of an ovarian cyst, or a ruptured ectopic pregnancy. Spectrum of imaging findings1 the accurate diagnosis of ovarian torsion is imperative, as loss of the ovary can have longterm consequences in terms of fertility. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy. Most patients with ovarian cysts are asymptomatic, with the cysts being discovered. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion.
Oct 22, 2019 ovarian torsion is commonly seen in women of reproductive age but can occur in other age groups as well. Rapid diagnosis and intervention are necessary to preserve ovarian function. The larger the cyst, the more likely that ovarian torsion will occur. The differential diagnosis for pain in women with ovarian cysts include tubo ovarian abscess, ruptured ectopic, ruptured hemorrhagic cyst, and ovarian torsion. Ovarian torsion, also sometimes termed adnexal torsion or tubo ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. The larger the mass, the more likely ovarian torsion will occur. A, there is a heterogeneous structure within the right lower quadrant that measures 6. Pdf ovarian torsion is a rare but emergency condition in women.
In contrast to adnexal torsion in adults, adnexal torsion in pediatric and adolescent females involves an ovary without an associated mass or cyst. Ovarian cyst the nest an ovarian cyst is a fluidfilled sac which develops in an ovary. Ultrasound is the preferred diagnostic test, but as we discuss later, the presence of blood flow detected by ultrasound does not rule out ovarian torsion. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. Any ovarian follicle that is larger than about 2cm is termed as ovarian cyst. Torsion of malignant ovarian masses in this population is rare. A missed diagnosis of ovarian torsion in a patient with. It can be intermittent or sustained and results in venous, arte.
Its unclear how often ovarian torsion occurs, but doctors agree that its an uncommon diagnosis. Ovarian torsion is commonly seen in women of reproductive age but can occur in other age groups as well. Developing an ovarian cyst is usually not a cause for concern. However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to ct or mri the latter in pregnant or young patients as the first imaging study. Ovarian torsion adnexal torsion diagnosis and treatment. No treatment may be needed for certain types of ovarian cysts which tend to go away on their own. She presented to the antenatal clinic with acute pain abdomen. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release. However, a nonspecific clinical presentation in conjunction with a highly variable imaging appearance makes the diagnosis of ovarian torsion challenging. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. Physical examination may reveal lower abdominal tenderness. Dec 31, 2009 ovarian tumour or cyst can be easily removed till 28 wks of gestation thereafter it is not readily accessible and may precipitate preterm labour. Ovarian cyst an ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release the egg and continues to grow, then it forms a cyst.
An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Acute abdominal pain in children is encountered frequently, and the differential diagnosis is extensive. Dec 20, 2018 an ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. The spectrum of reported sonographic findings of ovarian or adnexal torsion has varied in. Aug 16, 2016 within the cyst was a daughter cyst, without significant bloodflow fig. Ovarian cyst with torsion presenting as a wandering mass in a newborn. Torsion commonly associated with ovarian cysts, which can act as a catalyst to the torsion process. The most common precipitating factor for ovarian torsion is the presence of an ovarian cyst or mass which rotates the ovary around the infundibulopelvic and utero ovarian ligaments.
May 29, 20 an brief discussion of pelvic ultrasound findings in a patient with ovarian torsion. It is basically a sac inside the ovary filled with fluids. The underlying pathophysiology involves torsion of the ovarian tissue on its. When the condition was not immediately reversed, the cyst ruptured next to the adjacent fallopian tube. Jul 19, 2019 the most important risk factor for ovarian torsion is ovarian mass. Upon surgical examination, it was revealed that the patient had. When the condition was not immediately reversed, the cyst ruptured next to. We evaluated cyst persistence in relation to cyst size and use of cc in the preceding cycle. Studies have shown the low accuracy of clinical evaluation for diagnosing ovarian torsion ovarian torsion. Ovarian cysts are common, especially with woman who still get their period. The size of the mass is positively correlated with the risk of ovarian torsion. Characteristics of baseline ovarian cysts in clomiphene. Aug 02, 2018 ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. Ovarian torsion ultrasound discussed by radiologist youtube.