Case of the Week: Ovarian Torsion (Ultrasound)

In this radiology lecture, we discuss the ultrasound appearance of ovarian torsion.

Key points include:
1) Rotation of ovarian vascular pedicle with obstruction to venous outflow and arterial inflow.
2) Enlarged, heterogenous ovary due to hemorrhage and edema.
3) Small peripheral cysts with “follicular ring” sign: Thick, hyperechoic rim surrounding follicles of torsed ovary.
4) Classically, absent vascular flow.
5) However, up to 60% of patients with torsion have normal color Doppler findings, and arterial flow may even be preserved!
6) Most common finding is decreased or absent venous flow.
7) Twisted vascular pedicle: Most definitive sign of torsion, present in up to 88% of patients.
8) “Whirlpool” sign: Flow within the twisted vascular pedicle.

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