Case Of the Week (COW) 26 Jan 2014
Answer:
RIGHT OVARIAN TORSION
Findings:
Large cystic lesion is noted in the right adnexal region and the pouch of douglas, abutting the posterior wall of the uterus. Small peripherally located cystic lesions noted. The periphery of this lesion appears hyperintense on T1W imaging and shows restricted diffusion, reflecting late sub acute hematoma. On contrast administration no significant abnormal enhancement is noted in subtracted images. Another cystic lesion is noted anterior to the above lesion in the right side. The above features were sugegstive of Ovarian Torsion , which was confirmed on followup.
Discussion:
The main differentials are Ectopic pregnancy, which often presents as a hemorrhagic adnexal mass. It is excluded with a negative serum β-HCG test. However, ovarian lesions presenting with subacute blood, such as a hemorrhagic corpus luteum cyst hypervascular nonepithelial primary ovarian tumors, and necrotic metastases, can mimic ovarian torsion The Lack of a twisted pedicle or evidence of normal ovarian enhancement should decrease the level of suspicion for underlying torsion. Massive ovarian edema is another condition that needs to be differentiated . Extensive stromal edema results from recurrent torsion and detorsion of the ovary without progression to infarction. On imaging, edema can be differentiated from torsion with infarction by the presence of enhancement of the ovarian stroma.
Ref: Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation Shauna Duigenan1, AJR--February 2012, Volume 198, Number 2
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai
Answer:
RIGHT OVARIAN TORSION
Findings:
Large cystic lesion is noted in the right adnexal region and the pouch of douglas, abutting the posterior wall of the uterus. Small peripherally located cystic lesions noted. The periphery of this lesion appears hyperintense on T1W imaging and shows restricted diffusion, reflecting late sub acute hematoma. On contrast administration no significant abnormal enhancement is noted in subtracted images. Another cystic lesion is noted anterior to the above lesion in the right side. The above features were sugegstive of Ovarian Torsion , which was confirmed on followup.
Discussion:
The main differentials are Ectopic pregnancy, which often presents as a hemorrhagic adnexal mass. It is excluded with a negative serum β-HCG test. However, ovarian lesions presenting with subacute blood, such as a hemorrhagic corpus luteum cyst hypervascular nonepithelial primary ovarian tumors, and necrotic metastases, can mimic ovarian torsion The Lack of a twisted pedicle or evidence of normal ovarian enhancement should decrease the level of suspicion for underlying torsion. Massive ovarian edema is another condition that needs to be differentiated . Extensive stromal edema results from recurrent torsion and detorsion of the ovary without progression to infarction. On imaging, edema can be differentiated from torsion with infarction by the presence of enhancement of the ovarian stroma.
Ref: Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation Shauna Duigenan1, AJR--February 2012, Volume 198, Number 2
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai