*Learning Objectives: The goal of this poster is to provide insight into the pathophysiology, clinical presentations, radiographic signs, and treatment of ovarian torsion. Furthermore, to display typical and atypical findings of ovarian torsion to help aid in early diagnosis. Proper identification of torsion and rapid imaging workup is crucial for prompt surgical evaluation and ovarian salvage. Atypical features of torsion can be easily missed and may require further radiographic imaging.

*Content Description: Ovarian torsion is rare but accounts for up to 15% of surgical cases involving adnexal masses (1). Risk factors include fertility treatments, underlying ovarian mass, pregnancy, reproductive age, and prior torsion (4). The most common clinical presentation is lower abdominal pain, followed by nausea and vomiting, making a clinical diagnosis difficult (1). Ovarian torsion results from twisting of the vascular pedicle leading to ovarian infarction.

Treatment requires surgical intervention and vascular detorsion which may preserve fertility if performed early. As a result, making an early and rapid diagnosis without unnecessary radiographic imaging is critical. Multiple radiographic findings across various modalities may be seen in ovarian torsion which are important to be aware of. These findings include ovarian enlargement over four centimeters, peripheral ovarian follicles, vascular swirl sign, abnormal positioning of the ovary, underlying ovarian mass, and lack or decreased flow on doppler (2,4) which will be reviewed. Atypical radiographic cases of ovarian torsion will be discussed and displayed. These include asymmetric ovarian enlargement under 4 cm, abnormal ovarian positioning, and inflammatory changes surrounding the affected ovary.

Proper radiographic workup is necessary to avoid treatment delays and ovarian salvage. Certain radiographic findings such as a twisted vascular pedicle on CT with ovarian enlargement over 4cm, or lack of flow on doppler should prompt a call to the gynecologist for intervention. Further imaging in the presence of pathognomonic clinical and radiographic findings does not require further imaging and treatment delay. In atypical or unclear cases, further imaging may be required including MRI or ultrasound. Common pitfalls include ovarian inflammation secondary to appendicitis, ovarian hyperstimulation syndrome, and pelvic inflammatory disease (5).

Zachary Brennan Aulgur MD

AdventHealth Orlando

Appearances