The extraovarian mass representing the twisted vascular pedicle was evaluated. To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. Because the appearance of the ovary improved after untwisting, it was not removed. Results. Obstetric and Gynecologic Ultrasound: Case Review Series. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. The twisted vascular pedicle corresponds to the broad ligament, fallopian tube, and adnexal and ovarian branches of the uterine artery and vein.11 Lee et al11 reported that a false‐positive diagnosis could be made in cases of ovarian tumor‐associated salpingitis, endometriosis, or hemorrhagic cyst–associated edema because these conditions could have findings similar to those of a twisted vascular pedicle. The patients selected for study were female patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography. Ghonge NP, Lall C, Aggarwal B, Bhargava P. Clinical symptoms and signs of ovarian torsion are often nonspecific, and imaging studies have a crucial role in making an accurate timely diagnosis. BL indicates urinary bladder; and C, ovarian cyst. However, the whirlpool sign was seen in all of them. Sonographic whirlpool sign in ovarian torsion. Here, we have described an additional maneuver, wherein during sonography the probe is moved to and fro along the central axis of the twisted pedicle. The term whirlpool sign is used in other contexts: see whirlpool sign (disambiguation). Akutes Abdomen der Frau: gynäkologische UrsachenAcute Pelvic pain in women—gynecological causes. On MRI, it is best demonstrated on axial T2 and T1 C+ fat sat sequences 1. It appears as twisting of the thickened vascular pedicle of the enlarged ovary. Ovarian torsion is a medical emergency. Sonographic and MRI features of ovarian torsion. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. 1. In 2 patients, the artery alone was seen in the proximal part of the pedicle, and it too was absent in the distal part (Figure 6 and Table ). The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Identifying Ovarian Torsion on Ultrasound. In 4 of 5 patients in whom blood flow was observed in the artery and vein in the pedicle, a tumor was also present replacing the ovary, and they were removed. In conclusion, the positive whirlpool sign in the twisted vascular pedicle is the most definitive sign of ovarian torsion. Learn about our remote access options. Blood flow in the twisted vessels is not seen in all patients. 2012;198 (2): W122-31. Rosen's Emergency Medicine – Concepts and Clinical Practice. A rare cause of acute abdomen after a sport-related blunt abdominal trauma – Torsion of a normal ovary in a pre-pubertal girl. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. Any queries (other than missing content) should be directed to the corresponding author for the article. Its location and gray scale features were noted. Accuracy of Pelvic Ultrasound in Diagnosing Adnexal Torsion. Among the 6 patients in whom the artery alone was seen, 4 had impending gangrene, and the ovary was removed. On untwisting, the ovary improved; hence, only the tumor was removed. Twenty patients underwent surgery 4 to 36 hours after the scans. Case 246: MR Imaging of a Complex Cystic Mass in a Newborn Girl. Helpful sonographic findings that have been described include the appearance of a cystic, solid, or complex mass, with or without pelvic fluid, thickening of the wall, and cystic hemorrhage. During a period of about 2 years 6 months, there were 21 patients with lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography. In a stable patient who is suspected of having acute abdomen what is the next best course of action? Fourteen of them had acute severe pain, and 7 had intermittent pain. An ultrasound of a patient with abdominal pain might reveal abnormally positioned ovaries, masses or ovarian enlargement. Vijayaraghavan SB. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use. Twisted pedicle appearing as a large hypoechoic mass (arrows). In our series, a color Doppler study of the twisted pedicle was performed. Her vital signs were stable with a blood pressure of 115/65, pulse 68, RR 18 and remained so throughout her stay. The ovary was viable in all 5 patients in whom flow was seen in both the artery and vein. However, the diagnosis of adnexal torsion poses a difficult challenge because the clinical symptoms are often misleading. 8 Ultrasound whirlpool sign in ovarian torsion. Pediatric Ovarian Torsion Clinical Update and Case Discussion. Oophoropexy for ovarian torsion: a new easier technique. The age of the patients ranged from 7 to 69 years. Seeing past the appendix: the role of ultrasound in right iliac fossa pain. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. *The sensitivity and specificity for ultrasound diagnosis of ovarian torsion are 72.1% and 99.6%, respectively (Rostamzadeh 2014). Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. Not considered appropriate in children; abdominal ultrasound is recommended. The MRI whirlpool sign in the diagnosis of ovarian torsion. Features of cystic teratoma were present in 6 patients, namely, a cystic mass with solid areas containing fat, hair, or calcification. Torsión ovárica secundaria a teratoma maduro de ovario, causa infrecuente de dolor abdominal agudo. The whirlpool sign or whirl sign of ovarian torsion is characterized by the appearances of a twisted ovarian pedicle seen on US or even on CT. Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-Conservative Treatment and Literature Analysis. If there is evidence of blood flow, especially if blood flow is present in the interior of the ovary, it does not exclude torsion but may suggest that a viable ovary exists. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 It can be detected on ultrasound confirming the diagnosis along with the other suggestive imaging features and clinical presentation 2. An ovarian mass with torsion of its pedicle was found in all of them. The whirlpool sign can be seen on ultrasound by moving the probe along the axis of the suspected torsion. The presence of a twisted vascular pedicle was evaluated. A, Snail shell appearance of the twisted pedicle (arrows). Tératomes ovariens matures et immatures : caractéristiques en échographie, TDM et IRM. Pediatr. The whirlpool sign is a more definitive indicator of torsion. Snail shell sign: Testicular/ovarian torsion. It appears as twisting of the thickened vascular pedicle of the enlarged ovary. In all of them, the whirlpool sign (Video 1) was seen when the transducer was moved to and fro along the central axis of the twisted pedicle. MR Imaging of Pelvic Emergencies in Women. Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axis, resulting in arterial, venous, or lymphatic obstruction. The clinical symptoms, history of associated pregnancy, and laboratory findings were obtained from the patients' records. Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion. If not treated quickly, it can result in loss of an ovary. In the second patient, the pedicle was gangrenous, and the cystic teratoma had ruptured, with leakage of fluid into the peritoneal cavity. Torsion may be intermittent and recurrent, with spontaneous detorsion, allowing arterial and venous flow to the ovary to be observed on ultrasonography. Utilidad de la ecografía en niños con dolor en la fosa ilíaca derecha. Because sonography is not 100% sensitive, Color Doppler ultrasound findings may be normal (blood flow maintained) despite the presence of ovarian torsion. Ovarian Torsion- The Pitfalls in Diagnosis and Review of Current Trends in Management. This is similar to the whirlpool sign described with caudal movement of the probe in malrotation of the midgut with volvulus.1213 The diagnosis of ovarian torsion is made only when this whirlpool sign is seen. BL indicates urinary bladder; and CYST, ovarian cyst. Emergent Complications of Assisted Reproduction: Expecting the Unexpected. Gynecol. In this study, the classic whirlpool sign was depicted in 2 incidences only in all cases (14.28%), and abnormal coils and loops were found in another two (14.28%). Interobserver reliability for computed tomography findings of adnexal torsion. The whirlpool sign or whirl sign of ovarian torsion is characterized by the appearances of a twisted ovarian pedicle seen on US or even on CT. Finding the ovaries on ultrasound is probably the biggest challenge when tasked with performing an ovarian torsion study. "Twisted vascular pedicle" and "positive whirlpool sign" are specific signs of ovarian torsion on ultrasound (4, 5). The diagnosis was surgically confirmed in all 20 patients who underwent surgery. AU Vijayaraghavan SB SO J Ultrasound Med. If the whirlpool sign was present on gray scale sonography, torsion of the ovary was diagnosed; torsion was excluded if the whirlpool sign was not seen. 70 PubMed TI Sonographic whirlpool sign in ovarian torsion. Working off-campus? If the whirlpool sign of visible vessels was seen on the color Doppler study, the adnexal structure was considered potentially viable, and that was indicated in the report. J Ultrasound Med 2004; 23(12): 1643–1649. Adnexal torsion: color Doppler and three-dimensional ultrasound, https://doi.org/10.7863/jum.2004.23.12.1643. 31 Tepper R, Zalel Y, Goldberger S, Cohen I, Markov S, Beyth Y. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The Egyptian Journal of Radiology and Nuclear Medicine. Please check your email for instructions on resetting your password. Approximately 20% of the cases occur during pregnancy 1. 2004;23(12):1643. If you do not receive an email within 10 minutes, your email address may not be registered, The ovary had features of gangrene or impending gangrene in all 8 patients in whom flow was not seen in the vessels of the pedicle and in 1 of the 2 patients in whom there was flow only in the proximal part of the pedicle. Radiol. There was an enlarged ovary with peripheral cysts suggestive of ovarian torsion in 5. Magnetic Resonance Imaging Clinics of North America. Neonatal Surgery for Giant Floating Abdominal Cysts in Females: Clinical and Surgical Management. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. The probe was moved to and fro along the axis of this pedicle, and the presence of a “whirlpool” sign was evaluated. The artery alone was seen in 6 patients. In the whirlpool sign, the hypoechoic band in the twisted pedicle, representing the vessels, was seen wrapping around the central axis. Unable to process the form. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). ?88% of patients with ovarian torsion [2, 10, 12]. Gynecological pelvic pain as emergency pathology. In all these patients, the ovarian mass or the ovary was excised. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Twist and Shout! Detection rates of only 46% to 74% have been reported because these findings are nonspecific for ovarian torsion. 2010;36:630-4. Duplex Ultrasound Evaluation of the Uterus and Ovaries. Ultrasound of Pelvic Pain in the Nonpregnant Woman. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. The whirlpool sign or whirl sign of ovarian torsion is characterized by the appearances of a twisted ovarian pedicle seen on ultrasound or even on CT scan. She denied any lightheadedness, syncope, weakness, or dizziness. and you may need to create a new Wiley Online Library account. An ovarian mass was seen on sonography in all the patients. Duigenan S, Oliva E, Lee SI. The purpose of this study was to describe an additional maneuver during sonography and to assess its diagnostic value in ovarian torsion. Emergency Medicine Clinics of North America. It can also cause an infection (peritonitis) in the abdominal cavity. Journal of Diagnostic Medical Sonography. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. Complications des tumeurs ovariennes présumées bénignes. Analysis of Clinical and Ultrasound Determinants of Adnexal Torsion in Children and Adolescents. Video 2 — To‐and‐fro movement of the probe along the axis of the twisted pedicle in the color Doppler mode showing the whirlpool sign of the visualized artery and vein. Venous blood flow disappears first, then arterial. The last patient was pregnant and did well with conservative treatment. Video 1 — To‐and‐fro movement of the probe along the axis of the twisted pedicle showing the whirlpool sign in gray scale. Obstetrics and Gynecology Clinics of North America. Ritchie J, O’Mahony F, Garden A. Its location and gray scale features were noted, and an additional maneuver was carried out. Guideline for the management of ovarian cysts in children and adolescents. Imaging of Gynecological Disorders in Infants and Children. Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature. Ovarian torsion usually occurs on just one side and can cause sudden, intense pain and vomiting. Although ovarian torsion is not common, it is a medical emergency. Conclusions: A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Dolor pélvico de origen ginecológico como patología urgente. Sonographic whirlpool sign in ovarian torsion. Whirlpool sign of twisted vascular pedicle; Underlying ovarian lesion can often be found; Uterus may be slightly deviated towards the torted ovary. Sonographic findings of ovarian torsion in children. In 2 patients, it appeared as a large hypoechoic mass (Figure 4), and in another patient, it appeared as an echogenic mass (Figure 5A and Table ). Pathologic diagnosis of the ovarian masses in the 19 patients in whom the ovarian mass was removed included teratoma in 6, serous cystadenoma in 4, mucinous cystadenoma in 2, a luteal cyst in 3, fibroma in 1, and hemorrhagic necrosis of the ovary in 2. In 13 patients, the appearance of the twisted pedicle was as a hypoechoic mass with a target appearance, either with or without a central echogenic dot (Figure 1). Twisted vascular pedicle showing the circular string‐of‐beads appearance of dilated veins (arrows). Treatment. The whirlpool sign is visualized by moving the ultra- sound probe back and forth along the axis of suspected torsion(eitheralongtheovarianligament,whentorsionof 2/3 of patients with ovarian torsion have had normal blood flow. The gray scale features of the ovarian mass were recorded. Use the link below to share a full-text version of this article with your friends and colleagues. A study by Lee et al11 shifted the focus to the observation of the pedicle instead of the ovary or the mass. Rarely is the “whirlpool sign” seen – twisted vessels in the ovarian pedicle. Ultrasonography findings suggestive of ovarian torsion include unilateral ovarian enlargement, ovarian edema characterized by the presence of a hyperechogenic ovary with peripherally displaced follicles and echogenic stroma, free fluid, and a coiled vascular pedicle (referred to as the “whirlpool sign”) 17 Figure 2. Nontraumatic Abdominal Pain in Pregnancy: Imaging Considerations for a Multiorgan System Problem. 23 (12): 1643-9; quiz 1650-1. Ten patients were unmarried, and 11 were married. Sonographic Diagnosis of Ovarian Torsion. They were investigated with gray scale and color Doppler sonography. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Isolated torsion of the fallopian tube in a 16-year-old girl: A case report and review of the literature. Point-of-Care Pelvic Ultrasonography in Emergency Medicine. Is There Any Benefit to Obtaining a Pelvic Ultrasound After a Negative CT of the Abdomen/Pelvis in a Woman with Chronic Abdominal Pain?. A and B, Two types of target appearances of the twisted vascular pedicle (arrows). All the patients who failed to show blood flow within the twisted vascular pedicle showed hemorrhagic infarction and necrosis of the adnexal structures. Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management. Methods. The immediate duration of the pain ranged from 8 to 72 hours. The rings are not obvious. (2004) Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. B, Color Doppler study of the twisted artery and vein. It was located between the ovarian mass and the side wall of the pelvis in 15, between the ovarian mass and the fundus of the uterus in 4, and between the ovarian mass and the urinary bladder in 2. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Number of times cited according to CrossRef: How to perform a gynaecological ultrasound in the paediatric or adolescent patient. BL indicates urinary bladder; and CYST, ovarian cyst. Learn more. Check for errors and try again. It’s unclear how often ovarian torsion occurs, but doctors agree that it’s an uncommon diagnosis. On the color Doppler study, the visualized ovarian artery and vein were seen winding around the central axis in 5 patients (Figure 3B and Video 2). Although this sign is specific for ovarian torsion, yet it had been variably reported as seen in 13–88% of patients with ovarian torsion , , . Ultraschall in der Medizin - European Journal of Ultrasound. Ultrasound Evaluation of Gynecologic Causes of Pelvic Pain. Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain. In 2 patients with cystic masses, the wall was thick, suggestive of torsion. Color Doppler study of the pedicle showing the twisted artery alone in the proximal part (A) and no flow in distal part (B). A Rare Case of Nine Twisted Adnexal Torsion Successfully Resolved by Conservative Laparoscopic Detorsion. Diagnostic value of transvaginal color Doppler flow in ovarian torsion. The MRI whirlpool sign in the diagnosis of ovarian torsion. 2007;37:446-51. Eur J Obstet Gynecol Reprod Biol 1996; 68(1–2): 115–118. Though absence of arterial flow is classically described as the color Doppler sonographic finding in ovarian torsion, this is reported in only 73% of cases . Diagnostic Dilemma in a 75-Year-Old Woman Presenting with Acute Pain in Her Abdomen. AJR Am J Roentgenol. Ovarian Torsion in a 5-Year Old: A Case Report and Review. {"url":"/signup-modal-props.json?lang=us\u0026email="}. It appeared echogenic in 3 patients, with a string of hypoechoic beads surrounding it, suggestive of dilated veins (Figure 2). CT and MRI are alternate imaging options in these patients. _____ 5. The cross section of a twisted pedicle can have an appearance of a target, a snail shell, and large echogenic or hypoechoic masses without any obvious layers produced by twisted vessels. 2. 39 Imaging of Female Children and Adolescents with Abdominopelvic Pain Caused by Gynecological Pathologies. The movement of the probe during the color Doppler study also highlighted the whirlpool sign of wrapping of the visualized vessels around the central axis. Sonoscan Ultrasonic Scan Centre, Coimbatore, India. Of the 6 patients who showed flow in the artery alone, the ovary was removed in 4, and all had hemorrhagic infarction or early hemorrhage. Australasian Journal of Ultrasound in Medicine. The findings were correlated with the surgical and pathologic findings of the affected ovaries and tumors. Absence of blood flow in the twisted pedicle and visualization of flow in the artery alone are predictive of nonviability of the ovary. On gray scale sonography, the whirlpool sign is seen as a hypoechoic band representing the vessels wrapping around the central axis. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. The visualized ovarian artery and vein were observed to be winding around the central axis (Video 2). Unlike that episode, however, this pain was also associated with dys-uria. A, Twisted pedicle appearing as a large echogenic mass (arrows). Whirlpool sign of adnexal torsion on CT: where can we find it?. Ovarian torsion image one Imaging of Female Children and Adolescents with Abdominopelvic Pain Caused by Gynecological Pathologies. Hemorrhagic infarction of the ovary or a mass was present in all the patients in whom no blood flow was seen in the pedicle. • Ovarian torsion 4. Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy. The ovarian mass in others appeared as a unilocular cyst in 3 patients, a multiseptated cyst in 3, solid and cystic in 2, and solid in 2. During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion. The ovary or the mass was viable in all the patients who showed flow in both the artery and the vein. The whirlpool sign results from a side-by-side arrangement of vessels with opposing flow directions, giving an image reminiscent of a whirlpool. Journal of Pediatric and Adolescent Gynecology. Diagnostic performance of CT signs for predicting adnexal torsion in women presenting with an adnexal mass and abdominal pain: A case-control study. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Added Value of Using a CT Coronal Reformation to Diagnose Adnexal Torsion. It is the most definitive prospective feature in aiding the diagnosis of torsion of the ovary, even though the number of patients is small. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. What is the most common confirmatory physical finding for peritonitis? Gynecologic Emergencies: Findings Beyond US and Advances in Management. Case Reports in Obstetrics and Gynecology. Recent reports have suggested that documentation of intraovarian venous flow is important in establishing the viability of the affected ovary.3 Lee et al11 performed a color Doppler study on the twisted vascular pedicle instead of the ovarian parenchyma to assess the viability of the ovary in torsion. a, bColor flow on Doppler US images demonstrates the twisted pedicle (arrows) in a 12-year-old girl with a large, mature cystic teratoma (T) arising from the left adnexa, representing the lead point for left adnexal torsion - "Pediatric ovarian torsion: a pictorial review" Adnexal torsion is reported to be the fifth most common gynecologic emergency condition encountered, with a prevalence of 2.7%.1 Prompt diagnosis and surgery may prevent irreversible adnexal damage. The probe was moved to and fro along the axis of the pedicle, and the presence of a whirlpool sign was evaluated. Obstetrics & Gynecology International Journal. Fig. This sign is valuable for identifying ovarian torsion in these patients, even in the absence of classic morphologic or Doppler features of ovarian torsion. The aim of this study was to evaluate whether their combination improved diagnostic efficiency of AT in patients presenting with a benign ovarian mass and abdominal pain and clinically suspected AT. The ovary can also show multiple cortical follicles. Usefulness of ultrasonography in children with right iliac fossa pain. Surgical treatment of ovarian torsion includes laparoscopy to uncoil the torsed ovary and possibly oophoropexy to … In this article, we discuss and illustrate the normal appearance and arterial flow … Valsky DV. Crossref, Medline, Google Scholar; 32 Vijayaraghavan SB. Transabdominal scans were performed with HDI 5000 equipment (Philips Medical Systems, Bothell, WA) using convex 2‐ to 5‐ and 4‐ to 7‐MHz probes and linear 5‐ to 12‐MHz probes. No flow was seen in the vessels (Figure 5B) of the pedicle in 8 patients. It is an acute condition that requires prompt surgical intervention to save the ovary. The whirlpool sign in a twisted vascular pedicle has been variably reported as seen in 13?? There have been few reports of an enlarged ovary with absent or markedly diminished ovarian blood flow on transvaginal and color Doppler sonography as a specific finding for the early diagnosis of ovarian torsion.89 Other studies showed the presence of normal arterial flow in 3 confirmed cases of ovarian torsion, which suggested venous thrombosis without arterial occlusion and a dual blood supply to the ovary as possible explanations for the occurrence.210 These different results indicated that, in partial or early torsion, both arterial and venous flow could be maintained with viable ovarian tissue. Case Report: Ovarian Torsion in Pregnancy – Diagnosis and Management. One patient was pregnant at 23 weeks' gestation. AB - The diagnosis of ovarian torsion is challenging and relies mostly on morphologic findings. Imaging Diagnosis of Right Lower Quadrant Pain in Children. sudden onset, similar to her prior ovarian torsion. Lee et al11 also reported 94% predictability of the viability of the ovary when arterial and venous flow was seen in the twisted pedicle. The possibility of ovarian torsion should be considered when an ovarian mass is discovered in the appropriate clinical setting. A palpable pelvic mass was reported in 10 patients, and it was found to be tender in 5. There was hemorrhagic infarction in all 8 patients in whom there was no flow within the twisted vascular pedicle, in the 2 patients in whom blood flow was seen only in the proximal part of the pedicle, and in 1 of the 4 patients in whom only the artery but not the vein was visualized. Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. The gray scale features of the ovarian mass were recorded. B, Color Doppler study of the pedicle showing absent flow. In ovarian torsion, if the viability of the ovary can be predicted preoperatively, an attempt can be made to untwist the pedicle and retain the ovary to conserve ovarian function and fertility. Journal of Minimally Invasive Gynecology. OBJECTIVE To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. Objective. A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015. Ultrasound with color Doppler is often the initial investigation. Pelvi acuta infiammatoria e non infiammatoria. Ovarian Torsion: Diagnostic Features on CT and MRI With Pathologic Correlation. 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